PL-13-1138Miami Shores Village
Building Department
40050 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
Permit Type: PLUMBING
MAY 2 2 2013
FBC 20 � 11 1-P
-Permit No. l
Master Permit No.
JOB ADDRESS: � S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcal# 1/- -3.3[06 - 013 — Qclo
Is the Building Historically Designated: Yes
OWNER: Name (Fee
NO Flood Zone:
City: /" S ko re S_ State: EL Zip: _33 / 31
Tenanta,essee Name: Phone#:
Email:
CONTRACTOR: Company Name: Co C rN% _ 1� 0 a ( Phone# -2 k
Address: L%(�(� a� V 2 dot
City:
Qualifier Name:
(�)s ova
State Certification or Registration #.
g_q_Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Valve of Work for this Permit: $ C C) Square/Linear Footage of Work: N) S
Type of Work: DAddress OAlteration ONew ORepair/Replace ODemolition
Description of Work:
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 NOWDUE $_ '
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 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 he charged
Signature
Owner
Contractor
The foregoing instrument was acknowledged before me this c The foregoing instrument was acknowledged before me this
day of ft .20 &-, by day of d 20 L3L, by , 0 —WUn IQ ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print: u®oZcA Nc� l Print }
My Commission Expires: My Commission Expires:
DAVID M DIPUGLIA
EXPIRES October 25, 2013
Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10W)(ReAsed 06J10f2( W)(Revised 3/15/09)
Y COMMISSION # /3/3935608
EXPIRES October 25, 2013 Zoning
Clerk