PL-10-422BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)
Owner's 7 r's Address 0 ,6 N rA /7
City/"', /c V(f/ ,s Y' j State 1 •
Tenant/Lessee Name
Email Cf/ !�/ f a7M UN (a Ck . ea) ut--
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name W ( l /a 1�t
Contractor's Address /9 A/O //h
City UT- l $ At Y' /
Architect/Engineer's Name (if applicable)
State
of Work For this Permit $ 1 E/ t t911-
Type of Work: ❑Addition ❑Alteration
Describe Work: S 77 ikl y
Miami Shores Village mmoma\v
Building' Department MAR 1 b 2010
BY_
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PRONE NUMBER: (305) 762.4949
Zip 33 / S
Phone #
'79/06 /VW /1/911 � k Ale -
County Miami -Dade Zip 3 u ' l 0
x
y19 `-`P Z. Phone #
G�{ -u-► i eve.
e 4t Zip 7S
Qualifier Name
State Certificate or Registration No. Certificate of Competency No.
Contact Phone
E -mail
❑New
Phone #
Phone #
* * * ** * * * * *** * * * * * * * * *** * *** * * * * * ** F * * * * * * * * * ** * * * * *** * * * * * *,* * * * **
Submittal Fee $ - Permit Fee $ /00. 4.A. CCF $ CO /CC $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $
k/? hone#
[ L-IL 1'
Total Fee Now Due $
Permit No. VL lO `
Master Permit No.
Flood Zone
& S - 2 - 2 3 y ?
Square / Linear Footage Of Work:
❑ Repair/Replace ❑ Demolition
Technology Fee $
Bond $
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) 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 l— --.... Signature
wner or Agent Contractor
The foregoing instrument was acknowledged before me this re The foregoing instrument was acknowledged before me this
day of h44(le.f1 20/O , by day of , 20 _, by
who is personally known to me or who has produced — I'D who is personally known to me or who has produced
wtilm
As identifica pri` tiho' 4, ake an oath. as identification and who did take an oath.
NOTARY PUBLIC: ; .������4 0 0 � % NOTARY PUBLIC:
=0,
Sign:
Print:
My Commission Expires: ,
* * * * * * * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
Sign:
Print:
My Commission Expires:
* * * * * * *, * * ** ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
4faCns Examiner Zoning
Engineer Clerk checked
At
Inspection Number: INSP- 138082 Permit Number: PL- 3- 10-422
Scheduled Inspection Date: August 30, 2010
Inspector: Hernandez, Rafael
Owner: HERNIQUEZ, ZAIDA & WILLIAM
Job Address: 9906 N MIAMI Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 27, 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
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number
Parcel Number 1131010180540
Page 3 of 34