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PL-09-1963Job Address (where the work is being done) Value of Work For this Permit $ ,� 00 0 X' Y Type of Work: ['Addition Describe Work: Notary $ Training /Education Fee s$ 1-KO Scanning $ .5 Radon $ Miami Shores Village Buildiig Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC Zoo, Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) Fr si e /'S'CC r t'1 ?hone # S ®s 2-6 Z Q-Q-( Owner's Address t iv q3' d City 4Awr i (She ,^2 State . 0 _ Zip /3 Tenant/Lessee Name Phone # E -MAIL: / .1' g t City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name b / fl / .J W . Contractor's Address At 9 $u, . /40(4 ad • City P. State r . Zip 31'9S3 Qualifier Name 11-6•JFL t Ey or Phone # /0- io- G Zd State Certificate or Registration No. fee- IY2.0(4 Certificate of Competency No. E -MAIL: 441— #451064 , g) yolioe, ee44 Architect/Engineer's Name (if applicable) ©Alteration ❑New ❑ Repair /Replace ❑ Demolition i4-c -- /•'t /fvvs e. • * 9:dcx�Y�Y**www**e4 xxxxx*********************F xx*nY 4exxxx*ak 4c �Y �YxxxxxxsYxxxxxxxxxxxx d:xnYxxxoYxx Su mittal Fee $ G� � tea Permit Fee $ . 145 CCF $ 5 .40 CO /CC Technology Fee 1 ' Zoning $ Square / Linear Footage Of Work: DPBR $ Permit No. Master Permit o.VL SOci 4z3 Phone # 7 44-.06- - 4? e Phone # Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ e269 /?L- o9/%6p See Reverse side - Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Signature The foregoing instrument was day of , 200_, by who is personally known tome As ident NOTARY PUBLIC: Sign: Print: t ‘-- cA (Revised 02/08/06) State Zip State Application is hereby i <.: o obtain a permit to do the work and installations as indicated. I certify that no work or installation has prior to t e 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 and a r= 4 nspecti a will be charged. ckn wledged before me this The foregoing instrument was acknowledged before me this.0 ar c " '' 0 4c.day of , 20 �, by rs.2r Lce't , or who has produced who is perso ally known to me or who has produced ification and who did take an oath. Lips _° I as identification and who did take an oath. NOTARY PUBLIC: 0,F/fair-ea,' My Commission Expires: NOTARY PUBLIC:STATr xxxxxxxxxr xxxxxxxxxxx�itYA +y�cx Sex A x'yrx f: Commission #DD685 •s Expires: J ► E APPLICATION APPROW JATIANTIc My Commisl;t ftlIC :STATE OF FLORIDA xxxxxxxxxxxx( , * e ;Commission #DD685086 88 xxxxxxxxxxxxx /A' j Expir .: J ■ 13, 2011 At 1/ 1 A tee' `T axu / c s c ins o r j ',; /' � _.1 �� Examiner 86 Signature Zip ntractor Sign: 1 Print: Qt. 4 7 Engineer Zoning Inspection Number: INSP- 130262 Permit Number: PL -11 -09 -1963 Scheduled Inspection Date: March 31, 2010 Inspector: Hernandez, Rafael Owner: HERNANDEZ, FRANCISCO Job Address: 126 NE 93 Street Project: <NONE> Contractor: LEYVA PLUMBING SERVICES INC. Building Department Comments NEW GAS LINE TO HOUSE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 30, 2010 Miami Shores, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 RC- 3 -PO q- 423 C L. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (786)282 -9014 Parcel Number 1132060133130 Phone: 786- 316 -0631 Page 2 of 23