PL-13-680Miami Shores Village
Building Department APR o 6 2013
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBc Zo
BUILDING Permit No. fq
PERMIT APPLICATION Master Permit No. r&
Permit Type: PLUMBING
JOB ADDRESS: 9{ 11 t4w IVB <ZA--
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: N re(Fee Simple
AAr1n.ec• rn "
City: fI-ZG et VY7 i
Tenant/Ussee Name:
Email:
NO Flood Zone:
State: �-
CONTRACTOR: Company Name: A 4 4 N4`®7s� MTC4AO' Phone#: Z�� �4�'
Address: 1 E; 15 9 1 0 Z Z -S
City: 1j 6 A �4 ! State:
Qualifier Name: --ZEU-,J S, ¢ QAA Phone#:
State Certification or Registration #: Ly, N L 0 4� Certificate of Competency #: _
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer-
Value of Work for this Permit: $ 15so . Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration n ew ❑Re air/Replace
Description of Work:
Submittal Fee $
Scanning Fee $
I Lr-.
Permit Fee $ /0 o� CCF $ CO/CC $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
❑Demolition
,49 1 -
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 ondition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith tha a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to aattachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w ichl occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app -W and a reinspection fee will be charged.
Signature.
owner or Pgent
The foregoing instrument was acknowledged before me this _
day of ft L , 20 6, by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature�__�,� NW
Contractor
The foregoing instrument was acknowledged before me this
day of A?Rl L , 20 1'5, by��v�,
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:94-1167--Sign: ii�l T
RUIZ
Print: C� o &a" o W G0MMrA0 #EE160143 S
Print: �..® �IEE160143
DFM33M MEN
My Commission Expires: Soadad tlith 1tt Stat, Imurenca My Commission Exp'' ` 17' 2018
t3ondad tiullat SAM Inauttawe
APPROVED BY
Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk