PL-10-21-2667 � � :
�..�\ �c;{ ��a ����'�
'���"� <
s a� � t
� . � � �
,�� � ��,,�"� iarr�i Shc�r�s Viila�e ��� � :, � � �� ����k�' � ���
� <.
�
�
,,,�.c � '����� 1005Q EVE 2 la�� �� � ��"� ��'� � r
� ���
���� �� ��� �� Miami Shores F�3313� �. � ���� ?
f ,� �;�� 305-795-22Q4 `��`t'����t��`����������
F.�,�E c 3 \ � . ::v. ,.`$�� ... ,i,... � - �
.:,a tN s;,. .. �
����{��� . ., , .. �: .�:;
` �+��������'������; Exp�r�f�on: �5/04j2022
�
Loc�ti�n Address Parc�l Nu�ber
w.a K� �� .,.�,,. ..r .. m__ ,���..e.. �.w�._,�_,..e.�... e�m .. ......� ��em.r. �� m..w _v,.....n . ...� ��v �t,�.�w���.���._�
1291 R4E 9��`6i S1`,iVliami Shc�r�s,Fl 3313$ 11320501�t�202
��� a � �������������
Cont�cts
.M.w_...A��s�.�.��_�...e.��.__��._ � ��..�.�.�_A� . __u .,��.�.....,.
' 1C?M13ATHAN 1EROIVE Own�r WESTEA�fD RLUMBIiVG C�ftR �ontraetor
� 1291 NE 9G ST C�REOS CO�OS
t
2C}1 W 24 51�,HIAIE,AN,F!�33Q1Q
� Business:3(�58636223 lcobos@we$tiandplumbingearp.com
�ther:7�62360298
� y�
t,._.__,__,�_._._._,...�,._._,.__,�.���.__.����_._.....�._._...___n_.,....�,..,_....___...................�r.,.,_.,._.._�........_......�,._..._.r.._.,�..._�_ �......_..,..._�n_...�...�.......,._m_..,.........._..._�__.._.,._.�.._.........�_...
�_.....,
ir�s eet�on Re u�sts:
i D�scri tian:REPLACE TU&FQR SHOWER FOR BATH AND � Valuatiors: $ 554.44
� ����`������
i REPIACE�OTH FLUM�fNG EIXTURES FQR��TH 2 f�2 i
� Total Sq Feet: O.OQ
� . .. ..
' �
Fe�s l�mount �aymants Date Paid Amt t�aid
Application Fee-Other $50.Q0 TOt�I Fees $21�.3Q
CCF $0.60 CM�ck#15757 111�4/202] ��,p,3p
D�aR Fee 52_40 Ceedit Card 10/14J2021 �50.40
DCA Fee $2.QQ
Education Surcharge SQ.2p Am�unt�ue: $O.Ofl
Permit Fee $SO.OQ
Scar�ning Fee $�Q�
TechnQlogyFee $�.SQ
Total: �110.30
t�1� 1 t°1 � }i
In consideratian af th� issuanc� ta me af this permit, I agree to perform the work cavered hereur�der in complianee with ail ordinances and regulations
pertaining thereta �nd in striet conformsty with th� plans, drawings, staf�ment� or specificatians submifted to the �roper �uthoriti�s af N11ami Shor��
Village, fn ace�pting this p�rmit I assum� r�span�ibili�y for al!�vark done by either myseif, my�g�nt, seevants, or employ�s. 1 underst�nd that separate
permits are requir�d for�L�GI�REC��, PLUM�ING, MECFIA€JICA�,WIhIDOWS, C?QC?RS, ROt�FfE�G and SWI��(NG POC1L work.
QWNERS AFF(QAVIT: I certif}r that a!I th�: foregoing information is accurate and work done in compliance with ail applicable laws
regulating canstruetie�n and zaning. Futherm�r�, !authorize th�above named etae to do t or
,-�
�°I � �.�1
Autharized Signature:t}wner ! Appiicar�t 1 C�ntraetor ! Agent D�te
Nouemb�r 04,2Q21 Page 2 of 2
� � �� ��a;� p� 4� ���� �� �
� a i �� %��.; t f'� 4,.��^ � �.. i.. �S
i i r s ill �� �E � � � �c��.� s��
,, �..k. ;
��� `'..
U I� I�1 �� t .w;� ,..���w ��-�``�-'�-�__��
1005�N�E.2nd Avenue, Miami Shares, Florida 3313� � �
re�:(305�795-22E74 Fax:(���}7s�-s��2 .� �
E�vs��c�r�c���.t€�c��tc����unn���t:(�o�}�sz-���� "����
��i� ��� �
��. � Master Rerrr�it Rlo.��°��- � � � � `���.~�,�
PEI�MIT' �1PPLI�ATIC�1\I su�t��rmit Nc�.���-� �C�- ��.� � ����,�
�����.���� ���c-r��c ❑ �o����� � ��vEs�c�N � Ex-rE�vs��� �}���EWa�
,
��.�n��f�� � r��c�-+a��c,�� ��ua�ic woR�s ❑ eHarv�E oF � ca�vc�L�A-raoN � s�oP
cc�N���c�ra� ���v����s
�a��o��ess: � �� � �"�
�itY: Miami Shores CountY: Miami Dade �i� � �,'
Falio/Parcel#:��°�° � � ��� �° � 1 C� � ts�he Buildin�Historie�lly C�esi�nated:Yes NO
C}ccupancy Type: La�d: Canstructic�n Type: Flood Za e: BFE: FFE:
��� w� ..Y`" � �� �
t�WNER:Nam�{Fee Simple Titleholder}. � � `1 ��' � � �� Phc�n�#: � ����'°�- � � ��
Address: ���� � ��
City. < � A� �`� State: � Zip: � �
TenantJ�ess�e Name: Phone#:
�
Email. � � � .
CONTRA�'TOR:Company Name: ���"� �� ���{���� Phone#;,„� C �q��
Address:� �
City: � State: Zip: �� ._�..._._...�
C}ualifiier Nam�: � ��C�� � Fhone#: � °� ���
State Certificati�an�r Registratic�n#: �� Certificate af Competency#:
CtESfGNER:Architect/Engir�eer: Phone#:
Address: City: State: Zip:
Value of Work far thEs FerrrsEte$ �� SquareJ�inear F�cat��e of W�ek:
1"ype of Work: ❑ �ddition ❑ Alfieration [� New RepairjReplace � C�emolitican
Descripteon of W�rk. t"'�
��c� � � � �
Specify cvlor of cotor thru ti/e:
su��,��at���� '� �� � ��rm�fi��e S cc�� c�/ec�
Seannin�Fee$ Radan Fee$ DBPR$ N�tary$
Technol�gy F�e$ Trainin�jEducation Fee$ Rouble Fee$
Structural Reviews$ �ond$
TOT��FEE NOW Dt1E$
(Revis�doa/z�/aoa.4)
� s
Banding Company's Name(if applicable)
�onding Campany's Address —
Ctty $tatC' Z�P
Mart�a�e Lee�der's Narr�e(if applicabEe}
f��rtga�e l�end�r's A,ddress
City State ��P
Applic�tion is h�reby made tca obtain a permi�to do the wark and instailations as indicated. 1 certify that na wark or installation has
commenced priar ta the issuance of a permit and that all wc�rk will be perform�d to meet the standards af a(1 faws regu{�ting
construetian in this jurisdiction. I understand that a separate permit must be secured for E�ECTRiC, PI.UM�ING, SIG�1S, P�C3�S,
FURRIACES,B�ILERS,NEATERS,T�NKS,APR�C}NDiTIC}NERS, ETC....,
C�WNER'S �FFI�AVIT: ( certifyr that alf the foregoing ir�farmation is aecurate and that al! wark wiil b� done in compliance with all
applicable laws re�ulatin�construction and zc�ning.
" �RN1N� `T4 QWNER: Y�UR FAILURE TQ RECO�tD A NQTI�E QF C EN�E ENT AY
RESULT IN Y�UR PAYING T"WI�E FOR iMPRQVEMENTS T� Y�l1R RR�PER . tF 1fQ�t1 IRiTEND
TQ Q�TAII� FltVA►NCING, C�tUSU�T WITM YQUR LEN�E� QR AN A �RNEY BEFQRE REC�RQINt�
YQ►UR RIC?T[CE �F �Q�MMENCEMENT.►,
Natice to Applicant. As a cc�ndition to the issuance of a bultding permit with crn estimated value exceeding$25Q0, the appdicant must
prar�ise in good faith that a ca�py of the nc�tiee of camrrrencement and construction lien !aw brochure wiit be detfvered ta the persor�
whase property is subject t�attachment. A�so,a eertified cc�py of the recc�rd�d natice vf commencerraeni rraust be posfed at the jerb slte
ft�r the first inspect€�n whtch oceurs seven (7) days after the buflding �ermit ts issued. tn the absen�e c�f s�eh posted natice, th�
insp�ction will nag be crpprpved and o reinspection fee wi/1 be eharged.
� ��
Si�natur� Si�natu
0 NER or A�ENT CONTR.A� �
The fore�oin�instrument was aeknowledged befQre rr�e this The foregoing instrument was acknowledged befc�re me this
�day af ��c" ���� �°'� �.2Q ' by �� day of � 2Q�.» _, by
�� � ' �i,�� '� ,wha is ersonall kna fl to �� ,� ,whc�is ersanall�known ta
me ar who has�roduced as me ar whc�has produced as
identi�ication and who did take an oath. identification anc!wh�did take an aath.
NOTA.RY Pt1�LIC: N�TARY PU�LIC;
Sign: '�� � � Sign:
� : �� � �� � ,
p Print:
��$� �
S �e•` �1� N�ta�y Publ�c�Stat�o(Fl�rida S�al: ,���i�"��"�r�'`=. h8YR1AM Rt�J�S
`��° 'n�`� Commissfon X GG 2�7642 '?�.' �`; Natar�+Pub(ic-5tat�of Fior'tda
���'��!"�i��r}`�'� hty Car�m.Expir����p 2,2922 <:
�: Cam�fs�ion�GG 2�7642
�_6on6e�d through NaEi�nal P#atary Assr�. ���o����`� �y C�r�m.E��leea Sep E,2@2�
�:��*��z��»:#�e***��e�a�*�**���;��az���**��:����������:�*���*�x:��:x:*��*�� ,,....,�� de kr � ��������'��* ������:���*�*�*
APPRQVEt��Y � � Plans Examiner Zoning
Structural Review Clerk
{Revisedo2I�412oz�}