PL-14-230Miami 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
FBC 20
FEB 0 0 2014
Permit No. A1�=-,gw
Master Permit No. ✓�/ &,w
JOB ADDRESS: ma NE q� S\'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: `1- SUC - C04 — 037-0
Is the Building Historically Designated: Yes
NO A Flood Zone: A E
OWNER: Name (Fee Simple Titleholder): fk1QCitXj0,C LS Phone#: 3CS• 333. SLIT 4
Address: % 7_60 ME Ob Sk
City: �&: env►; %\'Wq State: Zip: 33 &1b
Tenant/Lessee Name: Phone#: -'
Email: eo��C� e�at�s,cary•� vtcxtomOc�rrt cow
CONTRACTOR: Company Name:
Address: l2eIL10 S%.-3 S! .
3oS. 260• �iS'�S'
Ci State: 'F�-- 1'4 ..� Zi S16\��
City: {fit �v:. p:
Qualifier Name: U Ca u chit, Phone#: SOS -7-60 -C'tS&_C
State Certification or Registration #: C.1ZCk4 S 1,05' Certificate of Competency #:
Contact Phone#: 309.26o.gSS.S' Email Address:®weh�encsc�S•CO�nl1
DESIGNER: Architect/Engineer: IGV.V AdQ �A�TE Phone#: V8Q.3'eO•9TA
Value of Work for this Permit: $ % D Zao•C210 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration [ew ❑Repair/Replace
Description of Work: 6C oep�
Submittal Fee $ `�� �QD Permit Fee $ 3 CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
❑Demolition
TOTAL FEE NOW DUE $ M
Bonding, Company's Natal -e (if applicable)
Bonding Company's Address
City State zip
Mortgage Lender's Name (if applicable)
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 property is subject to attachment. Also, a certified copy of the renotice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the Z7-i—ltt is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee wil
C
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this 3
day of 20 1'1_, by Voc:® OVA, day of Fe, , 20'1 , by Lm�
who is pew onally known to me or who has produced who is personWly known to 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:
I� -
Sign: 0, Qn1A Sig,
Print ¢ M 10 FF 030887 Prin
''andad Thru Notary Pu It undewbm
My Commission My
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)