PL-18-3588 (2)Miami Shores Village
RECEIVED
Building Department DEC 041018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 r' tij,�,
INSPECTION LINE PHONE NUMBER: (305) 762-4949 cl h
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201':4 Master Permit No. - (D
Sub Permit No.4?` ]B=Z S32)
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 890 NE 92 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: //�� Flood Zone: B-F^E:: Q� FFE: ,� ,�n
OWNER: Name (Fee Simple Titleholder): ` T.4.c � Pho s6 3� 1 `t'`l0 Nk
Addres``s:II -qQ IE— —1 ,
City:ytamxL 0��S State: ��_ Zip-
Tenant/Lessee Name:r Phone#:
Email: t �lt�0.i�r� .y
CONTRACTOR: Company Name: FLORIDA LATIN PLUMBING CORP
Address: 2011 NW 33rd STREET
City: M IAM I State: FLORIDA
Qualifier Name: WILLIAM A MENDOZA
State Certification or Registration #:
DESIGNER: Architect/Engineer:
CFC 1427860
Phone#: 786 515 3177
Zip: 33142
Phone#: 786 515 3177
Certificate of Competency #:
Phone#:
Address: City: State: Zip:
00
Value of Work for this Permit: $I7 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ■❑ New ❑ Repair/Replace ❑ Demolition
De ription of work: NEW GAS LINE FOR PLUMBING FIXTURES, WATER HEATER, DRYER, STOVFl
Feevwx POOL HEATER.
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $
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
Zip
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 reinspecti n fee e charged.
Signature gnature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
l day of /�p�,, 20 & , by
/�G✓, who is rsonaIly nown to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: "C4L-,)
Print:4 14n0,� 1 c7,Xf ctr/ /6,,feo
Seal:
The foregoing instrume
nt was acknowledged before me this
day of {1z�y� /�, 20 le' by
who ' personallyknownto
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �>✓c� �C>✓F'.
Print: a "/r�i /'"-ter
Seal:
as
Notary PubhC State of Florida
Ana Maria Perez °u Notary Public State of Florida
a� Expires 021281202 y ommiasion 1'��`�`ea
'o�n Expires 02/28/2022
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)