PL-07-1443Miami 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 No. p1 01 -- 1443
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)
,ate. R Ot
Owner's Address 1 q 3
City in Amt SboR.+a -s, State
Tenant/Lessee Name
Email
Master Permit No.
GME C t.1 Phone # SoS • '1 °6Q • 3 CO 9
Zip X31 3!Q
Job Address (where the work is being done) 8 LI E, et.l. { .
City Miami Shores Village County Miami -D
FOLIO / PARCEL #
Phone #
Is Building Historically Designated YES ( .o-, Flood Zone
Contractor's Company Name D F jZ'
Contractor's Address MOS a, . 8R \1.E.
City E S .0 ( State
Qualifier Name (;LL.tS,(5)J
Phone #
30S- ee3•8Loo
Zip 331.'18
Phone # 45(.15-- 98 3- go
State Certificate or Registration No. LPOx 00 eq.q Certificate of Competency No.
Contact Phone E -mail O 66,R ( • (\ IAA son) (D AMER,' CT 14S • CO M.
Architect/Engineer's Name (jf
Value of Work For this Permit $
Type of Work: ❑Addition ❑Alteration
Deseribe Work:
G.ZeptR8a PE2wn i
Phone #
Square / Linear Footage Of Work:
['New ❑ Repair/Replace ❑ Demolition
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Notary $
Scanning $
Double Fee $
********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CCF $
Training/Education Fee $
Radon $
Structural Review. $
DPBR $
Violation date:
COICC $
Technology Fee $
Bond $
Total Fee Now Due $
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
IMPROVEMENT'S 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 • th is nce of a building permit w th an estimated value exceeding $2500, the applicant must
promise in good faith that a copy mmecement d lien law brochure will be delivered to the person
whose property is subject; to attic ` . < ���% '' -cf ce 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 Signature .�,r
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoin : instrument was acknowledged before me this La
day of ,20 by , day of v , 20 JO , by !g�t�2i d-L . s ®,j
who is personally known to me or who has produced wh' personall o to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOT P
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
HUBERT NUNEZ
<•, MY COMMISSION f DD 894714
. °Q
EXPIRES:
� , P September 11, 2013
•j q:�`' Bonded Thru Notary Public Undenadters
APPROVED BY Plans Examiner Zoning
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Clerk checked
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okAttt ev6-1-t-S-01