PL-13-1905%hh1h. Miami Shores Village
Buildin g Department artment AUG G 1 20i
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC ?0
BUILDING �)- 'Permit No. }�I I I
PERMIT APPLICATION Master Permit NAC,. 13 - (�
Permit Type: PLUMBING
JOB ADDRESS: 2 N•W •
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#•
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):_ 9 o A SS e-,r J7 I s f A s • 0 n P}..#;3ds 21 9—
Address•,' ll`)g P.W . 19 ".9L j i ye
City: State: 7ip: .�3(?�
Tenant/Lessee Name: Phone#:
Email: Vol
CONTRACTOR:Company Name: F 1Pe-rl-111 G G( Cv'41.one#:
Address: a2 9 /j,,�-" A n a✓ a I'
City: �#37 b/' T�& ►'Vex State: Zip: .?.30
Qualifier Name: r'A rdL A _ Phone#•
9
State Certification or Registration#: l Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer. Phone#:
Value of Work for this Permit:$ �S�o • SquaredAnear F��oo of Work: CT 1
Type of Work: OAddress DAlteration ONew "�Rcpaaiir/Replace ODemolition
De M, uR MOM
"
� �
A 4B 141E ,1. QI .SP.` Shck
Submittal Fee$ .�V CO Permit Fee$ 00-A)c CCF$ 02.40 CO/CC$
Scanning Fee$ 0 cx> Radon Fee$ 14- DBPR$ �'*5�3 Bond$
Notary$ Trainlug/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ � �_ J C)
Bonding Company's Name(if applicable) JJ
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of.the recorded notice of comet t be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In h b e f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature -z• , Signature
C�m er or Agent tractor
The foregoing instrument was acknowledged before me this The foregoing instrument acknowledged before me this
day of /�" ,20 1,3 by e)f-e/vf Z)e is®e'Q y e,- day of 11 ,20 2,by TV qar -Fe,'r-4-,r d e ,
who i to me or who has produced who' sonally fcnow to me or who bas produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Print �`"�e''•, _ SANDY ROMERO Print M-e r 6
s•
0 Rim
M Commission a; My Comm.Expires Jul 26,2015
y '•:�$,is Yq?.•` Commission#EE 116040 My app SANDY ROMERO
Notary Pulft-State of Paft
�y MY Comm.Expires Jul 26 2015
APPROVED BY 0 4`A-/�. Plans Examiner Zoning
Structural Review Clerk
(Rmised3/12012)(Rmised 07/10/07)(Revised 000/2009)(Revised 3/15/09)