PL-13-706Miami 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: L5— -I I tU V'j I ( 15 k
APR 0-
FBC 201
Permit No. l k� 710(--D
if r
Master Permit No. �:j AI - 10S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO
Zone:
OWNER: Name (Fee Simple Titleholder): C) E r,>r-- CO44 P,-) Phone#:
Address: q 193 3 e, 6,food V) P vv z r _ )
City: L30 =-A0 i bo /" State:
Tenant/Lessee Name: Phone#:
Email: Jp
CONTRACTOR: Company Name: c'l &,4 Z/ U tit,A oti1,
Address:
City:/b / , J State:
Qualifier Name:
33/5 V
S,(=, -9 l -4o 2 Z16
3 W.Z. e.s
State Certification or Registration #: D �-��✓ Certificate of Competency #:
Contact Phone#: '7,8 C ^ CR01 4- 22./0 Email Address: s, ,
DESIGNER: Architect/Engineer:
Valuelis Iermits-$==
Type f Work: ❑Address 0i
Desc tion of Work:
r Footage of Work:
Q49&ee $ y Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ 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, BEATERS, 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 will not be zp roved and a reinspection fee will be charged. pI
or
The foregoing instrument was ack
day of Wlo, L , 205-, by )r
who is personally known to me or
+ledg me this
�.•`�aY Pul�.,�� HEIDY CERTAIN
NOTAR _ • Ntaty Public - State of Florida
�& Comm. Expires Oct 3, 2016
Commission # EE 840251
Print:
My Commission Expires:
4th.
The foregoing instrument was ackrlo400
^efore me this
day of t'i)' /� L �20� b���r--'5
who is personally known to me-o'who has produced
as identi4cation and who did take an oath.
NOTARY PUBLIC:
Sign:
&.,.,4,.-.1;ires:Commission
otary Public SPrint: tate of Florida
NMy Comm xpiresMy Co # EE 840251
APPROVED BY .1 X, (fd 1 ! "(�` /� Plans Examiner Zoning
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)