PL-07-1181Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING CX01081
PERMIT APPLICATION 4 b°
FBC 2004
(1-
JUN 0 7 2007 m
Permit No. 'PLO — 11
Master Permit No.
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) 04'401 f 7 Phone #
Owner's Address /06 Q /0 a7
City City 4/1,4- 4,4,-ShejeraS State 4
Tenant/Lessee Name /J % 4
E -MAIL: (►J 1 ittr j
Zip .°,ode:
Phone #
Job Address (where the work is being done)
City Miami Shores Village
1O47OQ ti►g to at
FOLIO / PARCEL #
Is Building Historically Designated YES
County
Miami -Dade
Zip
Contractor's Company Name W • e
NO
LJ)).3/4) - Ola
Contractor's Address '040
City .4)4 State Zi p • .��O
Qualifier Name 2.42 /1? fir§ ,s ' Phone # (z )
State Certificate or Registration No. ep'e /140262,21,1 ,Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ i 0 Square / Linear Footage Of Work:
Type of Work: ❑ ddition ['Alteration ❑New Re air /Re lace
p p El Demolition
Describe Work:° " ele iticuu
***,****** ** * * *xxxWW *,* * * * *** *,* ** ** * ** ** Fees*,************* **,** * ****** ** ***** * ** *** * * ****
Submittal Fee $ Permit Fee $ /6 el
Notary $ Training /Education Fee $ 0 -2,0
Scanning $ 6 Radon $
DPBR $
CCF $ a.Q CO /CC
Technology Fee $. 'q -D
Zoning $
Bond $ Code Enforcement $ Double Fee $ /_ / Aa
Structural Review. $ Total Fee Now Due $ tcO O'�'(% , ! `��r� 1 3 PAIP
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 jurisJiction. 1 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 AFFIDAV
applicable laws regulatii
T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
g construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOUR IMPROVEMENTS TO YOUR PROPERTY. W YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: Asa condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith tI'at a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subje 4 to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection Which occur seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr,° j ova: ection fee will be charged
Signature _
0
The foregoing instrumen
day of C
who i personally know
, 20
ner or Agent
was acknowledged before
by
me or who has produced
NOTARY PUB
Contractor
The foregoing instrument was acknowledged before me thi
day of1 ,2
byee.6n Lez-n
i personally known o me or who has produced
as identification and who did take an oath.
ARY PUB
A identification and who did take an oath. ?'
,_ Commission #DD
Expires: 06, 2008 Thru Mantic Bonding Cos .
Sign:
Print:
Print:
My Commission Expires.,
APPLICATION APPRO
(Revised 02/08/06)
My Commission Expires:
o1-ZEOS x aY ************aYxde************
Plans Examiner
Engineer
Zoning