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Miami Shores Villages
Building Department NOV 2 2013
MI
10050 N.E.2nd Avenue, Miami Shores, Florida 33138'
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
BUILDING
PERAUT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 1'+ o O 1 v u_ ID
Permit No. P1 /3
Master Permit No.A OIJ " 266!2
City: Miami Shm County. Miami Dade Zip:
Folio/Parcel#: fl— 22}7i — t?
Is the Building Historically Designated: Yes O Flood Zone:
City. _ml's mI � _ State:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: 3 40 h W U
City: ft
Qualifier Name:
State Certification or Registration #:
E�
rL Zip: -33, 0
of Competency #: f,
Contact Phone#: Email Address:
DESIGNER: ArchiWct/Engineer: Phone #:
oD
Valve of Work for this Permit: $ D Square/Linear Footage of Work:
Type of Work: OAddress 0#Iteration ONew d(Repair/Replace ODemolition
of Work:
51`N
Submittal Fee $_'50f Permit Fee $ /54b — CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ TrainhWEdneation Fee $ Technology Fee $
Double Fee $ Seal Review $
TOTAL FEE NOW DUE $_ LL Z19t_
i
r4i
B�ondifig 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 re inspection fee will be charged. /
Signature Signature / F rwlf
Owner or Agent tractor
The for'egoifig instrument was acknowledged before me this The f oing instrument acknowledged before me this -7 I
day of , 20 by day VWbef 20 J3 byM l GXej
who is personally known to me or who has produced who is personally known to me or who hat produced
As identification and who did take an oath. .409Z O as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: r
My Commission Expires: My Commission Expires:
' . MARIA CRUZ
COMIASS10A1 # � �
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a nsa �; 09.2MG
APPROVED BY -() Plans Examiner g
Structural Review
(Revised3 /122012)(Revised 07 /10 /07)(Revised 000/2009)Revised 3/15/09)
Clerk