PLC-18-3623Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
9050 BISCAYNE BLVD, Miami Shores, FL 33138
Contacts
J'€fi
_i�lr"' -
Issue Date:12/07'/2018
Parcel Number
1132060100010
Permit NO.: PLC-12-18-3623
Permit Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approves!
Expiration: 06/05/2019
PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant
PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC
P 0 BOX 407, LAKELAND, FL 338020407 P 0 BOX 407, LAKELAND, FL 338020407
Other:863688747 Other:863688747
PLUMBING MART OF FLORIDA INC Contractor
DAVID HIGHT
21 SE 10 ST, DEERFIELD BEACH, FL 33441
Business:9543794020 RWennet@plumbingmartinc.com
Description: REFURBISH FIXTURES ADD FLOOR DRAINS Valuation: $ 56,000.00 Inspection Requests:
762 4949
RELOCATE SINKS
Total 5q Feet: 19,700.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$33.60
DBPR Fee
$25.20
DCA Fee
$16.80
Education Surcharge
$11.20
Permit Fee
$1,630.00
Scanning Fee
$3.00
Technology Fee
$42.00
Total:
$1,811.80
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$1,811.80
Check # 034874 12/07/2018
$1,811.80
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor
December 07, 2018 / Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
F-IBUILDING ❑ ELECTRIC D ROOFING
RECEIVED
DEC 0 6 1018
CO -
FBC 2UR
Master Permit No. CC-4-18-902 1
Sub Permit No.y 1 1. 16 "
REVISION EXTENSION RENEWAL
OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9050 bISCAYNE bLVD.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1132060100010 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Publix Supermarkets Inc. Phone#: (863) 688-7470
Address: PO Box 407
City: Lakeland State: FI. Zip: 33802-0407
Tenant/Lessee Name: Publix Phone#:
Email:
CONTRACTOR: Company Name: Plumbing Mart of Florida Phone#: (954) 379-4020
Address: 21 S.E. 10th Street
City. Deerfield Beach State: FI. Zip: 33441
Qualifier Name: David Hight Phone#: (954) 379-4020
State Certification or Registration #: Certificate of Competency #: CFCO 57511
DESIGNER: Architect/Engineer: Phone#:
Address: City: State
Value of Work for this Permit: $ $56,000.00 Square/Linear Footage of Work: _
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace
Description of Work: Refurbish fixtures, add floor drains, relocate sinks
Specify color of color thru tile:
Submittal Fee S
Scanning Fee $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Zip:
❑ Demolition
CO/CC $
Notary $,
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ( I • �—
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instru t was acknowledged before me this
�— day of I 20 by
tAi.\A ' aA 44„` ye- who is personally known to
me or who has produced
identification and who did take an oath.
as
Signature X OCCJ-Zc�o
CONTRACTOR
The foregoing instrument was acknowledged before me this
1 day of .,eLyt- 20 % � by
who is personally known to
me or who has produced "i 1A as
identification and who did take an oath.
NOTAR UBLIC: NOTARY PUBLIC:
Sign: v lA---e— Sign:_S�o,,-.Q g. CA
Print: -f Print: 5l (Cs/G 4 ?— w N�
Seal: Seal: """
1f%f P% DONNETT It)VYE °A-k pu:'' SHEILA R. CUNHA
o
* MY COMMISSION I GG 054362 ? r; � : Notary Public - State of Florida
a Commission k GG 071848
EXPIRES: December 1Z 2020 � ��Ar My Comm. Expires May 6, 2021
***** *4000+�MY.+i0�t4NRti'1k�*********************************** ,,OF C**** N i0#040Ne**4INirhryAsI** **********
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)