RC-18-247, 1284 NE 94th StMiami 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
APR 2 3nl
FBC 2011 6V1
BUILDING Master Permit No.RC 18-247
PERMIT APPLICATION Sub Permit No. REV 18-3664 ' voy-19-W-
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION ❑RENEWAL
❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1284 NE. 94th St
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 1 1-3205-010-0140 Is the Building Historically Designated: Yes NO_
Occupancy Type: SFR Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Suzanne J. Giller f/k/a Suzanne Jacobs Phone#:305-754-4482
AAArocc. 1284 NE. 94th St.
City
Miami Shores
State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR: Company Name: M G PLUMBING & SPRINKLER SERVICE INC phone#: 305-525-9236
Address: 1265 NW 203 ST
city: MIAMI State: FL Zip: 33169
Qualifier Name: JAMES W. NYCUM Phone#:
etency#:
State Certification or Registration #: DESIGNER:CFC056920 Certificate of Comp —
Architect/Engineer: Address: Phone#:
City: MIAMI SHORES State: FL Zip: 33138
Value of
Work: Addition 7 0.60 Square/Linear Footage of Work: Approx 85 sq ft
❑ ❑■ Alteration ❑ New Q Repair/Replace ❑ Demolition
Description of work: Plumbing work associated with updating 2 existing bathrooms, including removing and
replacing vanities, remove and reset toilets, tub, etc as needed.
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
N/A
N/A
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 $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 �) ENT CONTRACTOR
The foregoing instrument was acknowledged before
me this The foregoing instrument was acknowledged before me this
day of 21 20 1 y ! y y
b day of+�/lL 20 /b
NYCUM
Suzanne J. Giller who is personally known to DAMES W. wl`o is personally kn9v?n to
me or who has produced FL Driver's License
identification and who did take an oath.
NOTARY PUBLIC:
Sign: 02J
Print:
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
as
f ; uWILLiAMS liunuvry
Seal: Seal: MY COMMISSION #GG105
EXPIRES: AUG 08, I
dotaN.••5��
�G • ��� Banded through 1st State Insurance
APPROVED BY L ��� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)