RC-13-2196Miami 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: /U` r lag- '?7 sr
SEP 2 6 2013
FBC 20
Permit No. VP_ l 3 —j;� d
Master Permit No.1 1a y 1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#• 32 G s --GJ ;Z — 042. p
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): la-4-1111-sA ��. Phone#:
Address: /G✓ S� /lv� ��
City. state F-
TenantAL4essee Name:
Email:
CONTRACTOR: Company Name:
Address: 1.2.2Of ,f z l
City-
, G."'),, r
Qualifier Name:
/2F- CT
76.) = 3AF= roti
p; 331"
&'
.?05-- _PZ (—OJ -S Z
State Certification or Registration #: C VC r,/ 1- � Certificate of Competency #:
Contact Phone#: 4-03-7G`6 Email Address: r JrAZ
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ f av Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ONew ORepair/Replace ODemolition
Description of Work: 'rd /e-✓ 44, 016k � _z�rklIct"k,"
Submittal Fee $ t) Permit. Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 constructionif �ochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the r� encement must be posted at the job site
for the first inspection which occurs seven (7) days after the builn the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be char edd�
g
Signature iI_ /,?Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this
day of .-20 , by e
who is orally kno a or who has produced
As identification and who did take an oath.
The foregoing instrument was acknowledged before me this-- 09 -
day of d3"I-- /u , 20 !2 by Ate' /4.
who is p Wally kn� me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ��`--�� Sign:
Print: f5� X Print:
ANTONIO SAY r ANTONIO SAY
My Commission Exp MY COMMISSION #FF052893 My Commission� " MY COMMISSION #FF052893
iN', •
9 CQ: M1�r"
EXPIRES September 10.2017 ''•.,?s'o,,p;oP�•`' EXPIRES September 10, 2017
(407) 392-0153 FloridallotaryService.com (407) 398 0153 FlorldallotaryService,com
k9r4e�kde�k4nYak3rsY�YskatrBr�Yde9ade9e4e'leak�YVeie&drrk9e�4dedade&'8rdesY9rfe&4rdear4r&dnY&�Yatr'�'eskdc9rik�YaYde�ir8e9e9e�le4ad:3i'sie�k9r&4rat�YBraYde9ede4nY�ir4e8aatr9r�k karat'hde�rskardrrk+Trie3rrk&cY�tnY9e�k
APPROVED BY ea - / Plans Examiner
Structural Review
(RMsed3/12/2012XRevised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)
Zoning
Clerk
Miami 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: (3057 762.4949
&vi arAIc,-1.
BUILDING
,a
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: /Of 5- fA- 17 -
SEP 2 6 2013
FBC 20
Permit No.
Master Permit No r
ROOFING
City: Miami Shores County: Miami Dade Zip: 331
Folio/Parcel#: ll --?.2- 0 %7— Of;? - 0/-2 C)
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): �m dy � Ce`'I Phone#:
Address-. 1615- N$,� Y7 ST—
City: Ai..�,, A,"" State: Fz_ Zip:3�-
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
Address: 2.20 St/
City: i e� �-•
Qualifier Name:
a /.0
Zip:
d D S -Z
State Certification or Registration #: Cl✓cc% AW12- Certificate of Competency #:
Contact Phone #: ;4Fil - -7 3 S-':'- AG/ a Email Address: / `j/1l° 0—'-- 0 � 'cL ` /x IS e- t/e e--1�a'°
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ /� S Square/Linear Footage of Work:
Type of Work:,QAddition DAlteration ONew ORepair/Replace ODemolition
Description of Work:
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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 ' issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. NA
C
Signature_
Owner' or Agent
The foregoing instrument was acknowledged before me this
day of -fX-11e�;'ZO ��, by /� A i:)e c-- t
who is p sona1Iknees me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Contractor
The foregoing instrument was acknowledged before me this
day of .ft, ,4 , Z, , 20 i .1 by �Cty+ /— /i oyK,
who is rsonall to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: C ----c
Print: All
My Commission ExpireL(4039"153
•s MY COMMISSION #FF052893 My Commission ' -Q3 MY COMMISSION #FFQsm3
EXPIRES September t83eEXPIRES September 10, 2017 �°.`��" FlorldallotaryServlce.com
1(407) 398 0153 FloridalloteryServtce
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APPROVED BY
Plans Examiner
Structural Review
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
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