PL-12-0661 (2)Miami Shores. Village
Building Department
fM NX2W Avenue, Miami Shores, Florida 33138
Tek (305) 7952M F= (305) 756.8972
INSPECTION'S PHONE NUbflW1h (305) 762AI949
FBC
BUHjDING Perndt No. VON
c5l
PERNRT APPLICATION Master Permit No. (o
Permit Type.- PLUMBING
City: Miami Shod countr---- Miami Dade zip.
Folk&arceW.
Is the BWldbg HisWicaft Deskood: Yes NO __-----flood Zone:
OWNEW- Nanic (Fee Simple Titleholder):
Addrem
city: State:
TenanVlawe Name. —Pbone#.-
Email:
coNT"cToR% Company Namr. -Phan& -706) 240 -
Address:
City: —stow. —zip.,
Qualifier Name: —Phouck 7 VO - 350k+
State Cofific won orftgwmiqff,,= 6fr- 14711S54 Certificate of Compftwy
,.y .
Aftm&- -SIA SVO�,- 6i- 0,600 - GO
F~ of We,*-.
=, ... Mill Olt M1
L%b=Md Fee Permit IF" $--2 CCF CO/CC $
ScawftFa$
Itsolon Fee $
Notary $ TftWWWEohwadw Fee $
Double Fee $ —wractow Review $_
DM`R $ Bond
Te&aeWff Fa $
TOTAL FEE NOW DUE $_
Banding Company's Nam Cif amble)
Bonding Company's Address
City su to zip
Mortgage Lender's Name (if applicable)
Mortgage lmdees Address
7-
�P
Application is hereby made to obtain a permit to do the work and installations as indicated. I cefify stmt no work or installation has
commenced prior to the issuance of a permit and that all wait will be performed to meet the standards of all laws regulating
coon in this jean. I understand that a separate permit must be secared for EL CI'RICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOnMS, BEATERS. TANKS and AIR CONDITIONERS, ETC,....
OWNER'S AFFJDAVU I certify dmt A t% foregoing information is act and the all work win be done in compliance with all
applicaMe laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
MPROVEN[ENTS TO YOUR PROPERTY. IF YOU MIUMD TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COAMENCENIENTr
Notice to Applicant: As a condition ur the issuance of a building permd with an estimated value exceeding $25M, the appU aunt must
promise in good faith that a copy of zbe notice of commencement and construction Here law brochwe with be delivered to the person
whose pmperey is subject to anachment Also, a cergW copy of the recorded notice of com wnce►uent must be posted at the, job site
for tke 149 inspection which occurs seven (7) days after the building perarat is issued In the absence of such posted notice, the
inpcdm WX approved and a rewspecdon fee will be charged.
1
Signature signature
Owner or Agent Cartractor
The fore ing irumem was T e foregomg instrument was acknowledged before me thi�
day y of /h.�2 .2a� by
who ' laxown tome wtm tas prrduc ed who is personally known to me or who has produced