PL-13-2210Miami 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
OCT 012013
FBC 20
Permit No. 13
Master Permit No. & Z' � — 2 N- z
JOB ADDRESS: 9301 N Bayshore Dr
City: Miami Shores County: Miami Dade 4p: 33138
Folio/Pazcel#:
11-3205
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Tideh
AddrPe". 9301 N Bayshore Dr
Guy Kurlandski
City: - - - State:
Tenant/Lessee Name:
Email: guykuriandski@hotmail.com
CONTRACTOR: Company Name:
Address: /4/ 9? s% A ��n e -
NO Flood Zone:
305.297.0803
X 6 94-3 /?W
City: Ant st LV c/e State: Zip: 3 95'3
Qualifier Name: 11LE Q, / M , Phone#:
State Certification or Registration #: AV2�06 Certificate of Competency #:
gi�
Contact Phone#: � U1P 3 L/ Email Address: YA 0611
DESIGNER: Architect/Engineer: r amp ell Phone#: 305.528.3037
Value of Work for this Permit: $ 23, 000 Square/Linear Footage of Work:
Type of Work: ❑Address &Alteration Mew ORepair/Replace ODemolition
Description of Work: W'w ("W i'<\ (7 `i-jC-) Lam; ti a) -"—n h�3 `o 5 z� tits QC-` - f Lr -'J S
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF
CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
londing 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 b 'ng permit is issued. In the absence of such posted notice, the
inspection will not be appr ved and a reinspection fee will be c
Signature s
Owner or Agent Contractor
The foregoing instrument was ac#nowledged before me this I The fo4 instrument was acknowl Lbefo me this—7—
day of'Ai"`,('' .' 20 a by V. t day of t , 20 L13, by ,
wh(Lipersonally lrnnwn rte_. or who has produced who is personally known to me or who has produce
As identification and who did take an oath.
My Commission Expires:
as identification and who did take an oath.
NOTAI t IL JOSE OHICH
s ' COMA EE15750
EXPI 09, 2016
Sign:
Print:
My Commission Expires:
APPROVED BY
Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk