PL-11-2018Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
U .DING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address:
City: d`a.
Tenant/Lessee Name:
Email:
1ij1OCj32O11
Permit Not i t) 3
Master Permit No.
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State: ) Z--li 014
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JOB ADDRESS: ' 6
City:
Miami Shores County: Miami Dade
Folio/Parcel #:
Is the Building Historically Designated: Yes
Zip: S 13
Phone#:
zip: 3 3 ( 3
CONTRACTOR: Company Namee:: / a P ,T
Address: !9� { &� 7 -3
City: i
Qualifier Name:
State Certification or Registration #: lJ
Contact Phone#: ' o
DESIGNER: Architect/Engineer•.
NO >K Flood Zone:
State: �*
671 1,4
/� / Lertificate of Competency #:
Email Address: /14,/,7?), f "I/ 't ' � l ft"-
Phone#:
Value of Work for this Permit: $
Type of Work: DAddress ❑Alteration
Description of Work: it- /)c 1
viko
Vy
Square/Linear Footage of Work:
O❑New ❑Repair/Replace ❑Demolition
rr) I�i.44 ! / /I'l. ate f 'n-1`' d1' / 1 y-� -,La ?..
-e c� ti� V\ o 4S.-e
* ** aye*** ***s*****s** ***e ******** *e ** * ** Fees ******** **** * * ** ******e***** *ear **** *********
Submittal Fee $ Permit Fee $ f CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ) CR .1U
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 A}FIAAVIT: 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 prope is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at t 'ob site
Signature /t/' for the first i pection which occ . r seven (7) days after the building permit is issued. In the absence of such pow e, the
inspection will i t be approved , " ; reinspection fee will be charged. 4.---*
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Contractor
Signature
wner or Agent
The foregoing instrument was acknowledged bef re me this'd f
day of CO— ° , 20 I , by Dew i A ru✓t:k
who is personally known to me or who has produced '
As identification and who did take an oath.
NOTARY PUBLIC:
s 1 •—
Sign:
Print
My Co
* * * * * **
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NELYS GONZAL
= *; • MY COMMISSION # 00974070
6' EXP1R�S Aprt103, 2014
7 .: 153 F
APPROVED BY
The fo
day o
w
•
�.
0 1S
N
'r
Co
by
mall known to a or who has produ
' )cation and who did take an oath.
A PUBLIC:
• •
Sign:
Print
My Co
ssion
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I/ Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
* * * * * * * * * * * * * * * * **
Zoning
Clerk