BPP-11-2248 (2)Miami 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
BUILDING
PERMIT APPLICATION
FBC 20
TM-MITI)
la o 6 2011 oil
Y:. ....................o
Permit No. 11--9.2,
Master Permit No. , e 1 t-'2—��
Permit Type: PLUMBING
O$NER: Name (Fee Simple Titleholder): Q Q W1rP atetri2 Phone# 9).5 *5 • 1)-1 g
I, N�
Address: `` * Aye/
City: YnhkVf 6vIote,12 State: 'l..
Tenant/Lessee Name:
Email: t ayharol ri &Ittardt,( WLai l . oww
JOB ADDRESS: OW9 kYg
City: Miami Shores County:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO
CONTRACTOR: Company Name: t 1 IAWll Cvvvt 430
Address: (L 51A1 11I *Ye.
City: WI.torW .1.� {" n State: Zip: ,531 t
Qualifier Name: t/WS rf € VI CI L/ py
64 Phone#: �J5j 1 I 4300
State Certification or Registration #: C.pG Certificate of Competency #:
Contact Phone #: 305' 5V1 t 305 Email Address: l 1 A M t CU Vt4 f Ool, s allot ' f &5 • !Awl
DESIGNER: Architect/Engineer: Phone#:_ 1
Zip: 1ll 1171
Phone#:
Miami Dade
Zip:
Value of Work for this Permit: $ Square/Linear Footage of Wor
Type of Work: °Address °Alteration °New
Description of Work: 12001 4 l r
* * * * * * *** ** ************ + *****+p** **w***+aF **** * * *** *** * ****** ** m*** ** *+m****.a*********
Submittal Fee $ Permit Fee $, CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
ending 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 CONDMONERS, ETC
O!WNER'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 he such posted notice, the
inspection will not be approved and a reinspection fee will be
Signature
The fo;
day o
who is person
Owner or A ent
Contractor
instrument was acknowledgedfore me his ([ �! The fore
ti , , t,t,do i , ru }i�c - State of Florida day of
NYnM, r r.._:.__ ...... who ,�,.- - gpq
=i:`s mucanil�F�iitia.N�it�C who is
* *niont"� Bonded Through Nat: n
dIdtake an oath.
My Commission Expires:
APPROVED BY Plans Examiner
Structural Review
(Revised 07110 /07)(Revised 06/10/2009)(Revised 3115109)
Sign:
Print:
My Commission Expires:
Zoning
Clerk