PL-09-1537 Yet�a r .
Ow
tom, w, Miami Shores Village
10050 N.E. 2nd Avenue �
Miami Shores, FL 33138 -0000
h Phone: (305)795 -2204
1 Expiration: 05/22(2010
.,
Project Address Parcel Number Applicant
347 104 Street 1121360130120
Miami Shores, FL Block: Lot: CYTHIA HORI
Owner information Address Phone Cell
CYTHIA HORI 347 NE 104 ST
MIAMI SHORES FL 33138 -2017
Contractor(s) Phone Cell Phone Valuation: $ 1 ,00 0. 00
NATIONWIDE POOLS INC (954)227 -7665 Total S Feet: 0
_..... _ y
Type of Work: PLUMBING For inspections please call:
Type of Piping: POOL (305)762 -4949
Additional Info: Available Inspections:
Bond Return: Inspection Type:
Classification: Residential Final
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $0.80 PL -9-09 -35914 $ 184.60 $ 50.00
Education Surcharge $0.20
Permit Fee - Additions/Alterations $180.00 PL -9-09 -35914 $ 184.60 $ 184.60 $ 0.00
Permit Technology Fee $0.00 Check #: 13021
Scanning Fee $3.00
Submittal Fee $50,00
Submittal Reversal Fee ($50.00)
Technology Fee $0.80
Total: $184.60
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 work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
November 30, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 30, 2009 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. .O k —)_3 I
PERMIT APPLICATION S P 1 6 ?003 M `ster Permit N all P �A_�
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address N
City (1;,ii . �a ` 2,T State "`t- Zip I
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) (C�tak t
City Miami Shores Village County Miami -Dade Zip �~j
FOLIO/ PARCEL # 1
Is Building Historically Designated YES NO r
Contractor's Company Nam r � � F ) Phone #
Name -- ,
Contractor's Address
City `�"°� iii �✓L 3'� Stat Zip 3,
ualifierName — � - r - Phone#
n
State Certificate or Re No. !� Certificate of Competency No.
E -MAIL: �.
Architect /Engineer's Name (if applicable Phone
Value of Work For this Permit $ �`. .. -- Square / Linear Footage Of Work:
Type of Work:
L __P ddition ❑Alteration ew El Repair/Replace Demolition
Describe Work:
YxxxxxxYxxxxxxrxrxrxxY r rrrxYxxF
Submittal Fee $� • Ud Permit Fee $ �,'f CCF $ 0• CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side
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
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) das after th building permit is issued. In the absence of such posted notice, the
inspection and harged.
Signature Signatu
Contractor
The foregoing instrument was acknowledged before me this ! I The foregoing instrument was ackno ledg before me this&
day of , 20� by ��J - day of ; 20� by
who is tero Ily known me or who ha produced who i erso ally krtown me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NO ARY PUBLIC: NOTARY PUBLIC:
Sign:
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of �
Print: Yetl 22 5 Print:
Commission Ex ires gr, fr FxpIres21812012 ° a V I'm UUU
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y p a A My Commission fix' M �y ExplresZ18 /2012
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Y ®Y4E ®eticc ccccss ®casein." C
APPLICATION APPROVED Y: t ,`�°� 1 r�' Plans Examiner
1 Engineer
Zoning
(Revised 02/08/06)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING ECEU VE0, Permit No. _P0 -0
PERMIT APPLICATION P i 6 ?009 M ster Permit N �� -(��3
FBC 2004
Permit Type; Plumbing
Owner's Name (Fee Simple Titleholder) Phone #
Owne 's Address C '=
City _ State J 'L Zip
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # _j 1 2 56
me t
Is Building Historically Designated YES NO
"i
Contractor's Company Name Phone #
Contractor's Address
City nJ p State Zip
Qual ifier Name AMt; rte: - Phone #
State Certificate or Registration No. C `� ,� a Certificate of Competency No.
E-MAIL: ?,
Architect /Engineer's Name (if applicable) AP Phone #
Value of Work For this Permit $ `' o Square / Linear Footage Of Work:
Type of Work: dition ❑Alteration ew
r � ❑ Repair /Replace ❑Demolition
r �
Describe Work:
ORA r.xxxxic i:r. icxiexic is r.xr. ie r. xic is r. r. r. r. is r. x ees xxxxxrrrrxrx x ie ie r,xri: ticxr.xxxr. x�c i; r.xxr. xie r,xxi; xic rx
Submittal Fee $5 • Ud Permit Fee $ r CCF $ 0•00 CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ (O' Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due 0 M&an
See Reverse side —>