PL-08-40030u(o1 W61•
VArovwd-
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2004
Permit Type: Plumbing
REEINE®
MA 0 2008
- J
Permit No. \ 08 -11{D
Master Permit No.
Owner's Name (Fee Simple Titleholder) oil* Cu IA niv16 NA14.1 Phone # 3 a S- '1 S� t S706
Owner's Address 24 in( `. Q S•‘.
City rv..,t s &Ok.t,o State (( Zip 3 31 3 r
Tenant/Lessee Name
E -MAIL:
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip 3 31 381'
FOLIO /PARCEL# l/3 6D /3(, 97CJ
Is Building Historically Designated YES NO
Contractor's Company Name T6( );h00. 1 1
n fii Ph 7s(„ o f-c G Dqa)__
Contractor's Address 0571- . O ci0 )Orn
City 1 ► fi 0A4A State Zip 5f ( e
Qualifier Name 7A4I7er 4-- r � Phone # 7 p ejc-1'g- �^�%�.�
State Certificate o,i Registration No. / f
E -MAIL: CA_ 1"
C.-.6;) re .p. a - `QA.
Architect /Engineer's Name (if applicable)
t
Certificate of Competency No.
Phone #
CO � r �- e q�c� �t�r�_
Value of Work For this Permit $ 3�, £ ) 1Jr Square / Li ,, . ,P ,Wini+kt, : 0"
Describe Work:./
yMU►
❑ wNK �/
Type of Work: ['Addition ❑Alteration
tl SIAIL ?it lc9C.lL v� ✓0 X30
c�leae 9 Cana ed'
Wall 00 ! witio
❑ Demolition
d 00
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * ** * *** ** ** ** * * * *** *** ** * ***** *** * * ** * ****
Submittal Fee $ 'CJ Permit Fee $ /70 CCF $ ®• (0 CO /CC
Notary $ Training /Education Fee $ 0.40 Technology Fee $. +2.5
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ µ' Double Fee $
Structural Review. $ Total Fee Now Due $ IlB.O
MAR 1 8 211'38
AKk11) 005
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the .first inspection which occurs seven (7) days after the building permit is issued. In the absence of s posted nc ice, the
inspection will not be appr d and a reinspection fee will be charged.
Signature
Signature
0 ner or Agent �� ontractor
The foregoing instrument was acknowledged before me this dk/a411'he / he fore oin instrument was acknowledged before me this 4 -7-
day of , 200 g by MA/e 2,E atlNnJtA,l$tf/q0 day of , 2 , by .. ids zM
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. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY ' UBLIC:..
Sign:
Print:
My Commission Ex
ullllulul
Ny
** * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED
(Revised 02/08/06)
* * * * * * * * * * * * * * * ** ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
3 t% L - - -- --._
My Commission ExpF[� °P Bonded ThruBudget Notary Servfcec
Plans Examiner
Engineer
Zoning
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 03/28/2008
Inspector: Levrock, James
Owner: Cunningham, Marjorie
Job Address: 28 98 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: INTERNATIONAL ALF QUALITY CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number (305)758 -1500
Parcel Number 1132060130940
Lot:
Phone: (786)845 -9292
Building Department Comments
Install 2" well up to 20' ft deep galvanized pipe.
�n
°
Passed
n • e ► `c or Comments
\,_____-''
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Thursday, March 27, 2008
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