Plumbing ApplicationMiami Shores Village
BUILDING
PERMIT APPLICATION
BUI ING RIC
Build ing ep artment
10050 N E.2nd Avenue. Nban St+o'es• FlOwida 33LU
TN:(305) 795-2204 Fay j 30517"n
INSPECMN UME RiONE NUMBER: (305)
FBC20
Im� vermit no. "how I —
ROOFING
Sub Permit No..
UMBING MEOiANICAL PUBUC WORKS CjjANGE Of
CONTRACTOR
lOB ADDRESS:
Harm
r,rua
Flofia/pOIFUL4010
amok
Occupancy Type: ion T
OWNER: Name fee Simple Tt#ehol erj:
Address:
• r c' �►
�jr ��`, Sys ��
Tenant/Lessee Name.Erail
C0hMtACr0FL Company N
Address: _ i7 / V ) �
Qualifiw1kilaaw,
dinC.: P.7, f iC6005 f4
State Ceffificabon or Regi tion :
GNER: Athftftl/Engineer.
Address: 9•0- �•
Value of Work for this h
Workrtn$
Type of Wor1c: ❑ Addition
00%
Lraawni Dade
RENEWAL
CANCELLATION SHOP
DRAWINGS
m:
0 .00001
IS &awni('�smridly Desiputed: Yes NO MEMMMEN
y� Flood Zyne_ BFE fFE_
!l1: V r \4,0 it wiones: ?D 176 2 7-.o
Cep
f
mllwww. �7C4 -- 4 9? - 9 ?-6 e
?State. Zip:
Phone*-.
[w7wa ■ or ill y #
vnoneli:
GOl- �l4 si 1 ���"S Stater � Lp: 33 t S2
�, Y 9 4 sEV auareN�r Foata�e of wo�+c 72'e.0 �' ya
►v
m4, F ■ - �.
Specify color of color thru tile:
N '0
suanacai Fee S vc�k fee 5 c� $ cnlcc $
Scann*q Fee S Radon Fee S DBPR $ hatwv S
Teciw,oioCy Fee S lfaini%lfduratios rec $ Fee S
stn�a Revkws S fond S
To'iu Fff Now DUIE S
i
me or who has produced �
w..r
identification and v�h�s did take an nth.
NOTARY rue►K:
% 1b
Sin
Pr3nt . � tii �
VW
$Sol. pQYA4�Y PUIiL.�C
STATE Of FL�K�A
46
.f
ing Companys Name (If applicable)
Bonding Company's Address
city _ _ State
Mortgage Lendees Name (if applicable)
Mortgage lender's Address
zip
'pis as
��Td ,CetFd. I CtttifY mat rb w0� � installat*n than
App�ication Is hereby made to obtain a permit to do the work and ins�a��a�' rn*d to �t the standards of a� lr�u '�'� Liar tv the issuance of a permit and that all vrrork wild be WO �� for ELECTRIC, pLUM&NG, SIGNS, POOLS -
commenced
construction In this jurisdiction. I understana cnac a separate {mv��^
�.....,..« enu cse ucercRc TANKS. AIR CONDITIONERSp ETC.....
rurMrMoca, can%,c...aP ......_.. - — ---mac �.,..e .r.tY. aY
OWNER'S AFFIDAVIT.
applicable laws re4ulati
1 certify that III the foregoing informat+on is accu
no construction and zoning -
rate � that all work will be done in cvmN���� 14w ...,.. �-�
11111111q��
"WARNING TO OWNER : YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
O YOUR PROPER I V16 IF YOU INTEND
RESULT IN YOUR PAYING TWICE FOR IMPROVEPAENTS ^aAN ATTORNE BEFORE RECORDING
TO OBTAIN FINANCING, CONSULT WITH YUUK Ltriv��YOUR NOTICE OF COMMENCEMENT. "
f�►e issuQrr�e Q building Pe""it w+t� an estimated value exce�d+�tg $25Ws [fie
ant must
Notr"c, to Applicant: As a cnndrhon #o �fto the
c o the no�r'ce of c�omm�ncernen� and colt Hen low brochure w,K be *11-Vered at the Perso"
s
pn"Ise in goad forth t'h�t a copy � rx subject to aKafhmen#. Also.* a cert�fied copy of the rerorde�d notr�e ofcarnmentemeni rnu�xf Apo �' �ewhose ►�� �1_ _. � _ ..�:__ ..�.�,�t �.� «SUe�. In the obsenc+e f posted
for the first ins�pec#�o�n which occurs seven (7) days offer me o�rrrctrrry
Mspectron will not be approaed o+�d o rernxpeccr'ert j+ee will be chorged. �
-4,
'mr,
S49nature...
�OWNERr T
The toregoing;nstrurnent was acknowledged before me this
Signature.
CONTRACTOR
The foregoing instrument was ac
d,
Iffy\i Al j.a
V I cft*- k^%r% &ft ar 20 1 Dy 140000�1
mar �'
or mp�
who is personally known to
me or who has produced �
kno%vlefted befi" me this
. 20 7 n . by
who is pq( �-
11V� to
aw�
idenfiftation and who did take an oath.
NOTARY PUBLIC
Sign
Print',
Ilk
044 A SUM ALM911L
�� �� 1rA� �:1xfL�►la+vn Cis tS17�M
i��• •* 112010
�i�i�t��tiAw��i�������ii����li*�����#�i�M�i#i�+i�.M��i�1#i�*��*����i�r�i��►.�*M��i*�1!
APPROVEDOY Plane Examiner
z�y
_ truCturii �w��Mr
. "24V4144
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