PL-19-2130Miami Shores Village _ E V1
Building Department SE 1 //,,20'9
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: !till '
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit IN ++►�10
PERMIT APPLICATION Sub Permit No. 'TL 0�_ I1-2-i30
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Alc (� C Ir CONTRACTOR DRAWINGS
JOB ADDRESS: I Z IQ �+Q `v C / ✓ S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder):
Address: Yoz Al,:� 9z '
City
S
State: rG Zip: 173113
Tenant/Lessee Name: Phone#:
Email:
s8yt'
CONTRACTOR: Company Name: /"/�i�dUu� �LUyd/�y �a��,c��/ f Phone#:C 74% 762 — 6YVJ
Address: M/a3 YS SW /�/ z ST .
City: / )/ tw/ State: �y Zip:
Qualifier Name:
ne#:
State Certification or Registration #: / C F C (2 %V15' Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone
Address: pp��/►► City: State: Zip:
0V Value of Work for this Permit: $ 0. '� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
4�T —^
Description of Work: �v�r � 2�E��y.,'� ®r-- S .d/ /xIf
Specify color of color thru tile: /^+�l
Submittal Fee $ - pa % Permit Fee $ ' 0 V CCF $ CO/CC $ _
Scanning Fee $ Radon Fee $ DBPR $ Notary $,
Technology Fee $_
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I.'S +,,-> D
(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 $1500, 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
`w
g'►.
OWNER or AGENT
The foregoing instrLhnent was acknowledged before me this
1 day of &(- 20 �� by
Wr �� , who i ersonall wn to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: I,11,10-'
Print: _ :?
X
Seal: ?� 2
as
Signature ,
CONTRACTOR
The foregoing instrument was acknowledged before me this
Zq day of (]VU C1 U b 20 1 c by
,G(�e 1Ne�Cf'\2NACLfz. , who is personally known to
me or who has produced
identification and -who did take an oath.
NOTARY PUBLIC:
Sign:
Print: + '
MY COMMISSION #GG124297
Seal: EXPIRES: SEP 23, 2021
��OF1 Bonded through 1 st State Insurance
APPROVED BY lr—-/� Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:11/08/201:9
Location Address Parcel Number
1298 NE 95TH ST, Miami Shores, FL 33138 1132060144030
Contacts
Permit NO.: PL-09-19-2130
Permit Type: Plumbing - Residential
Work Clossificotion: Septic
PermitStotus: Approved
Expiration: 05/06/2020
YURI MORALEZ Owner
302 NE 92ND ST, Miami Shores, FL 33138
Home: 3057903849 yurimorales@gmail.com
ALL AROUND PLUMBING ENTERPRISES Contractor
INC
RENE HERNANDEZ
10345 SW 112 ST, MIAMI, FL 33176
Inspection Description: PUMP OUT & REMOVAL OF SEPTIC TANK Valuation: $ 800.00 Inspection Requests:
4949
Total Sq Feet: 3,200.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$115.30
Payments
Date Paid Amt Paid
Total Fees
$115.30
Credit Card
09/13/2019 $50.00
Credit Card
11/08/2019 $65.30
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 required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
O WNEIRS AFFI9AVIT: I certify, at a I the foregoing information is accurate and that all work will be done in compliance with all applicable laws
req lattThq constfuction and zonitfq. Futhermore, I authorize the above named contractor to do the work stated.
Auth"It Signature: Owner I / Applicant / Contractor / Agent Date
November 08, 2019
Page 2 of 2
-- Address ,�? � _ �OSTDS#{
Comments:
Signature