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PL-14-218Miami Shores Village g Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.494: BUILDING PERMIT APPLICATION Permit Type: PLUMBING Permit No. P/ 141 "-'�'-9/? Master Permit No. -IP / / GZ-67,19/� JOB ADDRESS: i®( o g I V E S L A V e-- City: Miami Shores County: Miami Dade Zip: ?J 3 ` S P. Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Addregw (Ot 0 city: [Sfi e—s ©o -JET1 I co 1� r'v-Fo n 1 3 State: 'TLI zip: 3 -3 ( �3 ?' Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: ne #: Address: Sib S NE; 13 041L4 city: N- M 16W 1 State:. q" L, Zip: a 3 1 Qualifier Name: L�Wl ) L A-& eT&X ^Phone #: jXr-f%3 ' ZLJV State Certification or Registration #: %e / �� Certificate of Competency #: Contact Phone #: 365,4113-200 Email Address: � 19C �/%) �r w 6- 0AT . A DESIGNER: Architect/Engineer. Phone #: X) 47 Value of Work for this Permit: $ o ©o . Square/Linear Footage of Work: Type of Work: DAddress OAlteration ONew epair/Replace ODemolition Description of Work. .�' -E' -- A}= d&0- Z—rei Submittal Fee $ Permit Fee $ ��(J . CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ZV O 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 ' I no a approved and a reinspection fee will be charged. /� r ;4G Signature Signature O er or Agent Contractor The foregoing inns+trument was acknowledged before me this rJ The foregoing instrument was acknowledged before me this��K day of V1,64 201 , by 1 M �X�l, day of 20 %r,, by -m #A) who is personally known to me or who has produced `r—L— % who is pe4onally kno me or who has produced As identification and who did take an oath. as identification and who did take an oath. \Wk%li1111II/ /,, NOTARY PUBLIC: e�.N``\ d Q 180�y' %,,,, Print: v � De, NOTARY PUBLIC: c Sign: akuO&Iwe P&U-0,-4- Print: Ale- d 4 My Commission Expires: - ""V - � ....• - My Commission /, / APPROVED BY -S'9 y Plans Examiner Structural Review (Revised3 /12/2012 )(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Posw my 9 MOMS S EXPIRES: May 30.2017 g�edTl�uN�1IU�� Zoning Clerk (.5-r ECEIVE FEB 0 5 2014 Ve GK CITY py� rA G � "C �P. co a ZWA elk 4 �IrJG �ao rZ �s 6,4 gj5p(Ae,OAP, Av-r TAiS s c°ri ©n� r