PL-19-720Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date.-06/05/2019
Location Address Parcel Number
351 NE 105TH ST, Miami Shores, FL 33138 1122310130290
Contacts
Permit No.: PL-04-19-720
Permit Type: Plumbing - Residential
Work Uassification: Alteration
Permit Status: Approved
Expiration: 12/02/2019
JERRY AND SARAH ENGEL Owner YERBILLAS SERVICES INC Contractor
351 NE 105 ST, MIAMI SHORES, FL 33138 JORGE YERBILLA
Business: 7864885212
Description: ALTERATION OF BATHROOM NEW SHOWER Valuation: $ 1,500.00 Inspection Requests:
RELOCATE TOILET RECONNECT SINK ON KICTHEN TO REPLACE 5-762-4944
PERMIT#PL17-2367 Total Sq Feet: 600.00
Fees Amount
100% Permit Renewal Fee $100.00
Application Fee - Other $50.00
Total: $150.00
Payments
Date Paid Amt Paid
Total Fees
$150.00
Check # 553
06/05/2019 $100.00
Credit Card
04/03/2019 $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 required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all %" will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do thFl work stated.
Authorized Signature: Owner
/ Applicant / Contractor /
Date
June 05, 2019 Page 2 of 2
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
O�
FBC 20c04461=ping
Master Permit No.
PERMIT APPLICATION Sub Permit No "�' _
[—]BUILDING❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION r_ ` ENW AL
❑■ PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 351 NE 105 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JERRY & SARAH ENGEL Phone#:
-J
Address: 361 �L, LC _ztlC
1�( A\kt � P
City: State: `'� Zip
Tenant/Lessee Name:
Email
Phone#:
L3
CONTRACTOR: Company Name: YERBILLA SERVICES INC Phone#:
Address: 2423 SW 99 PL
City: MIAMI state: FL Zip: 33165
Qualifier Name: JORGE L YERBILLA Phone#: 786-488-5212
State Certification or Registration #: CFC 1427286 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $2 ,CLC4c>, Square/Linear Footage of Work: 50S c� F
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �Y�- V g-4'\.D '�' CS� t ^� \.<L 4 Q3.j`A
tS —710 T-LM-FT
MM IT -PL 9_ �
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
CCF $,
CO/CC $
Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ l
(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
Zip
State 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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
.2``'7'- dayof ax k c4k 20 1 by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
dayof by
l
` who is erson own to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign: i1�c_ ign:
Print: �Q h -e J1 A— Print'
Seal: OW Notary Public State of Florida
�+0 � Notary Public State of Florida Seal: ; Jorge ONposa
Sandi Pena a My Commission FF 952774
r My Commsssm GG 244913 a a Expires 02/07/2020
V n/ Expires 0912&2022
****************************************************************************
APPROVED BY � L—/ JZ 0 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)