PL-18-676 (2)Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
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Permit NO. PL-3-18-676
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 4/26/2018 ] Expiration: 10/23/2018
Project Address Parcel Number Applicant
126 NE 107 Street 1121360070220
Miami Shores, FL 33161-7032 Block: Lot: ILEANA ESTHER FAJARDO
Owner Information Address Phone Cell
ILEANA ESTHER FAJARDO 126 NE 107 Street
MIAMI SHORES FL 33161-
126 NE 107 Street
MIAMI SHORES FL 33161-
Contractor(s) Phone Cell Phone
EPOCA CORP (305)778-5103
Type of Work: INSTALLATION OF WASHER AND UTILITY
Type of Piping:
Additional Info: INSTALLATION OF WASHER AND UTILITY
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$163.85
Valuation: $ 300.00
Total Sq Feet: 1000
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-3-18-66803
04/26/2018 Check #: 697 $ 163.85 $ 0.00
rwanaoie mspecu
Inspection Type:
Top Out
Final
Review Plumbing
Underoround
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 cgon)%tor to do the work stated.
Authorized Signature: Owner / Applica t
Building Department Copy
Agent
April 26, 2018
1
Miami Shores Village V<LUC LL
Building Department MAR 141018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 W
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 l Q A"1
BUILDING
PERMIT APPLICATION
[—]BUILDING ❑ ELECTRIC ❑ ROOFING
F B C 2017_-'-�
Master Permit No. �� kcs — ( 0
Sub Permit No. kA 'L2 _-_�
❑ REVISION ❑ EXTENSION [:]RENEWAL
Iz PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /� i,v�/ / S /
City: Miami Shores County: Miami Dade Zia•
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load
OWNER:
Address:
Simple Titleholder):
/U
Construction Type: Flood Zone
M
BFE: FFE:
ne#: 13%J_(n 49 _�'?/fl
City: If / A01 r _52t� State: Zip:
Tenant/Lessee Name: j�/d Phone#:
Email: f
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name: —� ✓t
State Certification or Registration M
4
Phone#: D
/— z Zip: 53/e/
Phone#: 526 6F4/O;3
of Competency #:
DESIGNER: Architect/Engineer: 'k . S Phone#:_-?05_—? !K 2�g7?s
Address: 7�.�� / �j% 6 Sb�. -go,, a/ City: N1 _ La— k State: � �j �Zip: vg J )rT L
Value of Work for this Permit: $ 6%� Square/Linear Footage of Work: /0,0 0�Q
1C- �
Type of Work: ❑ Addition Alteration New [Repa�ir/Replacee❑ Demolition
Description of Work: 1 n S &V����fJ10-" 6 - 1A1� CO i[1,AA'61 t
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ 4 b _ CCF $.
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ,/
(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.
OWNER or JJGENT
The foregoing Instrument was acknowledged before me this
—� day of 20 � by
ibo Y6i o is personally known to
me or who has produced � < (I �1 �i� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
MAHARAI K. GONZALEZ
Print:
:as EXPIRES: November 2, 2020
Seal: ' ; o: is°.Pr Bonded Thru Notary Public Underwriters
Signature
CONTRACTOR
The foregoing instrument was acknowledged before cmye- this
day of 20 /y by
r:2 J ) e who is�ersi3rra11yYo
me or who has produced/as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:%mif _ Comt*Won#GG113541
Evkes Am 1112021
Seal: aad�' eoad,dtlruead~ ow
************************************************************************************************************
APPROVED BY
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)