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PL-17-2503�s W%S LMiami Shores Village s 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 5—was Phone: (305)795-2204 F�OR1Dp' Project Address Permit NO. PL-10-17-2503 Permit Type: Plumbing - Residential Per ' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date:11/212017 Expiration: 05/21/201 Parcel Number Applicant 10555 NE 2 Court 1122310130600 Miami Shores, FL Block: Lot: JORGE LUIS RIOS Owner Information Address Phone Cell JORGE LUIS RIOS 10555 NE 2 Court (786)202-6660 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone HOME OWNER De of Work: POWDER ROOM PLUMBING FOR TOILET ONL )e of Piping: ditional Info: POWDER ROOM PLUMBING FOR TOILET ONL nd Return : issification: Residential Scanning: 1 Valuation: $ 2,000.00 Total Sq Feet: p Fees DueA$150.00 Pay Date Pay Type Amt Paid Amt Due CCF Invoice # PL-10-17-65414 DBPR Fee 2/2017 Credit Card $ 165.45 $ 0.00 DCA Fee Education Surcharge Notary Fee Permit FeeScanning FeeTechnology Fee Total: / $165.45 Hvauaoie inspections: Inspection Type: Top Out Final umbing Underground a In consi eration of th i uanc to me of this p rmit, I agree to perform the work co Bred hereunder in compliance with all ordinances and regulations pertaini g thereto and i st t co means, drawings, statements or speci ations submitted to the proper authorities of Miami Shores Village. In accepti this permit I su r onall work done by either myself, m agent, servants, or employes. I understand that separate permits are requireforELECTRICAL, L B CAL, WINDOWS, DOORS, RO ING and SWIMMING POOL work. OWNER AFFIDAVIT: I cerh at ao g information is accurat and that all work will be done in compliance with all applicable laws regulating construct n and zoning. Futher e, Ih above -named contraaror to do the work stated. \ l4 jrd \\ � _/ November 22, 2017 Authbrized Signatu ner ppli nt Contractor / Agent Date Building Depar�rrnt?W\\ November 22, 2017 V u 1 Miami Shores Village Building Department artment RECE►vE� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '11 g 111 Tel: (305) 795-2204 Fax: (305) 756-8972 PN INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ROOFING FF7BC 20r 1 q � Master Permit No. P—. (� I (O — 2 Sub Permit No. f � ❑ REVISION ❑ EXTENSION ❑ RENEWAL '7%hUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP — _ ✓i A _COjfl RACTOR DRAWINGS JOB ADDRESS: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Co struction Type: food Zone: BFE: OWNER: Name Fee Simple Titleholder /FFE: % ` ar—nwc) : Phone#: Address* City: State: Zip: Tenant/Less Name: . Phone#: Email: CONTRACTOR:Corn y Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ( CJ " Square/Linear Footage of Work: Type of Work: ❑ 7ition ❑ Iteration ❑ New ❑ Repair/Replace Demoliti n � U� Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $_ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CO/CC $ Notary $ Double Fee $ Bond $ tS TOTAL FEE NOW DUE $ (Revised02/24/2014) Notice to Appli s a conditionto the issuance of o building permit with an estimated value exceeding $2500, the applicant must promise in goo it tha opy i I e notice of commencement and construction lien law brochure will be delivered to the person whose propedsp-stuion bs ct att ch t. Iso, a certified copy of the recorded notice of commencement must be posted at the job site for the first hi oc s ve (7) days after the building permit is issued. In the absence of such posted notice, the inspection ill not op ov an a rei s ection fee will be charged. Signature OWNER or ENT The foregoing instrument_ was ac n be met C day of n (��c1� A(�Y� �� . ',, who per nal y known to me or who has produced as me or who has produced an who i take an oath. identification an who r take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: rs MY COMMISSION Ii GG 044602 EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwrite NOTARY PUBLIC: Sign: 'Print: 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 FINANCINMNSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." QME CEMENT." Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 by as identification ************************************************************************************************************ APPROVED BY © � Plans Examiner Zoning who is personally known to Structural Review (Revised02/24/2014) Clerk