PL-09-666BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) F!$G+0
Owner's Address 1. 4,4, /4e q3
City 14 E ' State. OZ..
Tenant/Lessee Name
Email
9
Job. Address (where the work is being done) � �� W
City Miami Shores Village: 1 County Miami -late
FOLIO / PARCEL # Ii " 204)1 -0t 3 SI `24
Is Building Iiistorically Desigliated YES . !I • • NO
Contractor's Com Na me & /LJ4 . P•/d b / /vj J.. f• Phone # 77 a gJf' sSR9 ✓
Contractor's Address /V99_ s gi /j V
City 21L1 dT' Gc
_ l G e State a. Zip . Yg3
Qualifier Name / 4 4 F A . L fr vim , . • Phone # 7 Ib' ,5 ?f
State Certificate or Registration No (Pit: /V2 Certifi9ate of Competency No.
Contact Phone 70-54 69a
Architect/Engineer's Name (if applicable)
A
'1rl
Value of Work For this Permit $ 1 0 _
Type of Work: ❑Additi9n
rs escribe Work: ZZGb '7
Submittal Fee $ Permit Fee $ • •
• Notary $ Training/Education.Fee $ • . I ' AO
• Scanning $ 3 ap Radon $ DPBR $ •
Bond $ Code Enforcement
' h
Structural Review. $ •
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C
Miami Shores Village pomEavizi
la APR 2 2 2009
BY:
Building Department
10050 hl. 2nd Avenue, Miami Shares, Florida 33138
TeL :1(305) 795.2204 Fax: (305) 756.8972
Iteration ['New
Zip S•
Phone #
E -mail a 4 I2 ia0 GCvn
Permit No. PI O ( (4p
Master Permit No /k.) 09 42 3
Phone# S•CoI— I. ,o7'
Zip • 3
Zoning _ $
Dnlblg twee $ �f ��
} Fee Now Due `$
See Reverse side -
Flood Zone
Phone #
Square / Linear Footage Of Work:
❑ RepairlReplace • iep
* * *** * *** * * *** * **** * * * * ** axe * * *** * * * *** Fees** * * * * * *** * * *e * * * * ** * * ** * * ** * * * * * * *** * * * **
CCF $ 4. D / C - O /CC
Technology Fee $ 5.63 3
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 diter the `building permit is issued. In the absence of such posted notice, the
inspecti ill not approved and a'rei on fee will be charged
Sign:
Print:
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 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 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."
Signature . r. .1 Signature
O 0 7 or ge ' Contractor
The foregoi g instrument as acknowledged before me this 21 The foregoing instrument was acknowledged before me this2 1
day of +rit- ,20' 4nc I co '15 /J p rIC , 20.B1by A bn€r . 14"Vvc
who is personally known to me or who has produced who is personally known to me or who has produced ! • As. identification and who did take an oath. Pi s identification and who'did take an oath.
L /00 Opp 77 (k7 0
NOTARY PU I LIC: NOTARY PU 1C°
• (Revised 07/10/07)
My Commission Expires: NOTARY !rid'.' -9T': OF FLQRIDA
NOTARY PU}3LIt-STATE OF ,,, Commission #DD685086
FLORID. IL.,,,�,,, -` Expires: �, 13, 2011
BONDEDTHRIIA CB;. 'INGCO.,INC
sl'!" : Comm p i p ssion #DT:685086 ;
BQNDED THRII ATL BONDING CO., INC.
APPLICATION APPROVE
a ****** ** ***,k ******** **
Engineer
Sign:
Print:
ire
?e . " Notary Public State of Florida
Daylin Samuel)
a < My Commission DD718895
ate E pines 09/19/2011
My Commission E
01
I. � - ,,,
,R:k ****$*,k***** * ** * * ** *** * * * * * * * * * ** • *** **
Zoning
Clerk checked
Inspection Number: INSP - 112217
Scheduled Inspection Date: March 19, 2010
Inspector: Rodriguez, Jorge
Owner: HERNANDEZ, FRANCISCO
Job Address: 126 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LEYVA PLUMBING SERVICES INC.
Building Department Comments
March 18, 2010
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
0 c
Permit Number: PL -4 -09 -666
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)282 -9014
Parcel Number 1132060133130
Phone: 786 -316 -0631
PLUMBING WORK FOR INTERIOR REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
37/5' /(--)
fr 6T
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