PL-13-1627I
VAHA -d
Inspector Comments
El
February 94,014 For lnepeetions please call: M5024940
Page 4 of 42
Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3055) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JUL 1 9 201 i3
f
FBC20,
Permit No. P
Master Permit NoHe
JOB ADDRESS: l Q C e G N M I c �, A d eyi
City: Miami Shores County: Miami Dade Zip: 2 d
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO V Flood Zone: A-0
OWNER: Name (Fee Simple Titleholder): L J ` cli (a C�yvy'Z' Phone #: 1 (r. 2-_1 I 3 cf
Address: I ® l ®q N �_k i o_r&X pj eo Ll_c
City: M I 1 (s YX 04 tf ' State: Zip: 3 3 'S 0
Tenant/Lessee Name: OLI I A Phone#: 'k) l A
Email: N 1 A
CONTRACTOR: Company Name: L1�P_n s Phone #: Cam) 2'(0E' -C1
Address: l '2-cl qQ SyI lj `b ,S b lt2_L I
City: NA I 1l. State: F Zip:
Qualifier Name: LA -z- Lluo-rcuck Phone#: ( -30 <�) o 'q G5 5
State Certification or Registration #: "C l q CD 'Z ®5G Certificate of Competency #:
Contact Phone #: 300 `? (OC - q 555 Email Address: L- URA C4`CU' C9 P 2e4 \,A @- j2Cy C i&'.
DESIGNER: Architect/Engineer: eo Ll. 0,a CLC b C etc Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew ❑Repair/Replace ❑Demolition
Description of Work:
1Pl �P_c .r PC CA
Submittal Fee $ Permit Fee $ Jf add- ® CCF $ CO /CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
- . -.
Bonding Company's Name (if applicable)
Bonding Company's Address N I J-N
City
State
Mortgage Lender's Name (if applicable) 0 0 a
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b approved and a reinspection fee will be charged.
rJ ^
J�ignature Signature C .
Owner or Agen Contractor a
The foregoing instrument was acknowledged before me this _� The foregoing instrument was acknowledged before me this 1$
day of 1- , 20 by Ll N (10 Mn day of Q !: , 20 13, by 117- rn . U V4 RI) 14,
who is pers ally kn�iden r who has produced who i �personaflykno"wntoa or who has produced
As tificati and who did take angath. as identificatiop and who did take an oath.
, INJItin .
I • • • 10 • _0 - — --
APPROVED BY ag�;a Plans Examiner
Zoning
Structural Review Clerk
(Revised3 /1212012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)