PL-13-2037Miami Shores Village
Building Department
10050 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
JOB ADDRESS: 125 NW 95 STREET
SEP 0 9 2013
FBC 20
Permit No. P ]j3-W2)4-
Master Permit No. R , R ' 2a36
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): B & L REALTY HOLDINGS, LLC Phone #: 305 - 519 -6968
A,m, .- 3900 W 2ND AVENUE
City: MIAMI
State: FL zip: 33127
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: ACA CONSTRUCTION Phone #: 305- 219 -3448
Address: 10725 SW 55 TER
City: MIAMI State: FL
Qualifier Name: ANDRES LEMUS Phone
State Certification or Registration #: CFC1427635 Certificate of Competency #:
Contact Phone #: 305- 219 -3448 Email Address:
DESIGNER: Architect/Engineer: Phone #:
33155
305 - 219 -3448
Value of Work for this Permit: $1800 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: REPLACE SHOWER HEADS AND VANITIES IN TWO BATHROOMS, REPLACE FAUCET
AND SINK IN KITCHEN & ATTACH EXISTING WATER LINE TO FRIDGE, REPLACE TILE IN BATHS (SEE FLOOR PLAN)
Submittal Fee $ Permit Fee $ CCF $ Lj CO /CC $
Scanning Fee $ Radon Fee $ 3, 3 L pa DBPR $ _5 :5 0 Bond $
Notary $ Training/Education Fee $ 9. Technology Fee $ , 6
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
U
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 be charged.
6
Signature Signature .
Zsmen't n r or ent Contractor
The foregoing.was a cknowledged before me this 3 The foregoing instrument was acknowledged before me this 3
day of SEPT 20 by MICHAEL BROMLEY day of SEPT 20 _,by ANDRES LEMUS
who ' -Pe sonally�kno o me or who has produced who is son ally known me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
C,1�1
Print: RONNI
My Commission Expires: * '� r�AY COMMISSION # EEO00673
'•mo EXPIRES October 01, 2014
r
Pri ° . I B W P� I NK
=* :*_ MY CQ11 M O C7040573
M n .fot c (11, 2014
(407) 388 015 rinsds'.%warysery ce.com
APPROVED BY (- / �',� Plans Examiner Zoning
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk