PL-19-632Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
321 NE 93 ST, Miami Shores, FL 33138
Issue- QA(27/t "
Parcel Nu
1
Permit NO.: PL-03-19-632
Permit Type: Plumbing - Residential
Work Classification: Addition
Permit Status: Approved
: 09/ C3/2019
Contacts + "` -V '-
i Hai
ELIZABETH COWEN Owner ELIZABETH COWEN • Applicant
321 NE 93 ST, MIAMI SHORES, FL 33138 321 NE 93 ST, MIAMI SHORES, FL 33138
Other:3054580120 Other:3054580120
PLUMB TECH GROUP INC Contractor
RAMON RODRIGUEZ
Business: 3054288685
Inspection
Description: ROUGH AND SET OF KITCHEN SINK AND GAS Valuation: $ 6,750.00 Requests:
4949
WATER HEATER.
Total Scl Feet: 360.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.54
DCA Fee
$2.36
Education Surcharge
$1.40
Permit Fee
$186.25
Scanning Fee
$3.00
Technology Fee
$5.91
Total:
$256.66
Payments
Date Paid Amt Paid
Total Fees
$256.66
Credit Card
03/27/2019 $206.66
Credit Card
03/25/2019 $50.00
Amount Due:
$0.00
Building Department Copy
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 Laclilirbo for E�ECYRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWN S AFFI Ice ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regu ting con o and Wing. Futhermooree,, II authorize the a}bbove named contractor to do the work stated.
;7//�
A ze i n ur er / Applicant / Contractor / Agent ate
March &201 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village v1
MAR 2 2019
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BY: �'
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No. ?L L� - 1 B
Sub Permit No. pL S "lq " b3 2-
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: J? N•� �I 5r-d .5T
,,�f
City: Miami Shores County: / /J4Nir Miami Dade Zip: 3 3/5
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 0 ► 2,Aht r' ( 01--{1 Phone#:
Address: � 2-1 AjL= C) i
City: :1 ► a&,I S lnor ► State: f L Zip: 33) 3
Tenant/Lessee Name: C (i Lo%lt i'11, ( 0w t'A Phone#:
Email:
CONTRACTOR: Company Name: 1— 11 IdA at?)( Phone#: ?>05—y Zt
Address: 716q s yj 4-7 S7-
City:-/x,►./ /l) State: 47L Zip:
Qualifier Name: RCA40'" _(/ �✓/�C,P Phone#: _i6 S r/
State Certification or Registration #: Cf� G Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: � City: State: Zip:
Value of Work for this Permit: $ 61
7-�J Square/Linear Footage of Work:
Type of Work: E� Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: U`'u L (% S�� C/d" �(TG( Q� S) v� 4?Q
Specify color of color thru tile:
Submittal Fee $ J Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $,
Training/Education Fee $
CCF $
DBPR $
CO/CC $ _
Notary $
Double Fee $ _
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ Z06 • (f )k>
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 a7b1ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature •cc,Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this
The f ego' g instrument was acknowledged before me this
r day of Mk GIV1 20 1 q by
2 �- day of (Arc VN 20 1 1 by
0 i I/A t A 1 l C „�, t who is personally known to
NCAM% C(,An who is personally known to
me or who has produced as
me or who has produced as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PU1�-�
Sign:
Sign:
Print:Ismael A. Pabon
Print: ,` Ismael A. Pabon
Seal: _ _ Commission;" GG082163
=*
Seal: fKRIr6S; March 13, 2021
Expires: March 13, 2021
Bonded thru Aaiun Notary
� ;;; �; ° bonded thru Aaron (Votary
���
APPROVED BY _ , /glans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)