PL-18-864 (2)�`,gµORES L,f
F�ORtDp'
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PL -4-18-864
Permit Type: Plumbing - Roaidential
' Worm Classification: Pool - Private
Permit Status: APPROVED
lssua Date: 4191201`8 1 Expiration: 10/06/2018
Project Address Parcel Number Applicant
1132050310060
MONICA SAVITS
Block: Lot:
Owner Information Address Phone Cell
MONICA SAVITS 1360 N. E. 103 ST.
Contractor(s) Phone Cell Phone
POOLS BY G.E. CORP (786)732-0614 (786)355-3382
ype of Work: POOL AND SPA PIPING
ype of Piping:
dditional Info: POOL AND SPA PIPING
and Return :
lassification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$3.38
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee
$225.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$235.23
Valuation: $ 1,000.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -4-18-67026
04/09/2018 Credit Card $ 185.23 $ 50.00
04/04/2018 Cash $ 50.00 $ 0.00
Hvanaoie i
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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 ELECTRI L, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI : ceify thA all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio an erm re I authorize the above-named contractor to do the work stated.
Anil �S tit V April 09, 2018
Author rat re: Owner / Applicant / Contfa for / Agent Date
Building Department Copy
April 09, 2018 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 APR 0 qia
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201Q
Master Permit No. nn I) t� 1�
Sub Permit No.2\ o C�%`A
❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
j� c CONTRACTOR DRAWINGS
JOB ADDRESS: I1A(ec) OF, log y,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: , *� 1 Flood Zone: BFE: FFE:
l
OWNER: Name (Fee Simple Titleholder): A � 1 C A S" `V t S Phone#:
Address: I q (0 V _Iy E In �_J -
City: W -PlI Cy1 t State: �� " Zip:
Tenant/Lessee Name: Phone#:
Email: POC A"
c f''7CONTRACTOR: Company Name: POCA � 0�a Phone#: / �� �23 2
Address: r 7 SW 2_ '
City: H 6(-wy)
qualifier Name: CSU' 1i-e(m o
State: 1 Zip: 33 1 E-6-
f `' t u' P L .� V"Phone#:7 850 35.5 330 2,
State Certification or Registration #: C (T— 145 98 K Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ l 000 Square/Li neap,rFootage.of Work:
�. p.
Type of Work: ❑ Addition ❑ Alteration j New Re
Demolition
Description of Work:
Specify color of color'thru tile:
Submittal Fee $ r'.. Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ ;XC 5 DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ 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. /
Signature
OWNE r AGENT
The foregoing instrument was acknowledged before me this
day ofL 20 JR by
(iNl I C A �V i who is personally known to
me or who has produced
identification and who did to a�,dq„
2 .
NOTARY PUBLIC:
Sign:
Print
Seal
ANAI EWUIVEL
* MY COMMISSION It FF 145850
EXPJi FS: July 28, 2018
Bon uBudgetNotayServices
as
CONTRACTOR
The foregoing instrument was acknowledged before me this
OZ day of �� lu_- �� by
who is personally known to
me or who has produced a
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: l IP6`
Seal:
*******************************************************************
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
W/ �
,PYNNotary Public State of Florida
Sindia Alvarez
aMy Commission FF 156750
OF Expires 09/0312018
�A A..I. a
* * **M#****************
Zoning
Clerk