PL-13-2571Miami 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: (3W 762.4949
BUILDING
PERMIT APPLICATION
Permit Tyx: PLUMBING
\V
Ni'V 13 262
FB+C 20 LD
Permit No.?L—`t S 571
Muster Permit No. •? " ��j��
JOB ADDRESS: 597 NE 93 Street
City: Miami shores County: fffflM i Dade Zip: 33138
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
-&MP
OWNER: Name (Fee Simple
Flood Zone:
1WwLf Uc
Address•. c -A Qi 3 S'r i
City: tA� c _n-� Stat:
Tenant/fessee Name:
CONTRACTOR: Company Name:
Ate: 1300 SW 70TH AVE
City: MIAMI
Qualifier Name:
LONCUS PLUMBING
BELLO
FLORIDA
State Cerrificatson or Registration #: CFC 1428066 Ceat::ficate of Competency #:
Contact Pbone# Email Address: LONCUSQAOL.COM
DESIGNER: ArchitecNEngineer. Phone#:
ob Square/Linear Footage of Work:
305-218-1044
33144
305-218-1004
Type of Work: OAddress OAlteration ONew ORepaidReplace O)emolition
Submittal Fee $ y" " Permit Fee $ �-� CCF $ CO/CC $
Fee Radon Fee DBPR Bond
Scannit� $ $ $ $
Notary $ TrainkWTducation Fee $ Teehnology 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 TRICAL 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
CON[MENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
EMPROVEMENTS 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 $25W, the applicant mist
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 comment must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the 7ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged A
Signature
Owner or Agent - e Pntractor
The foregoing instrument was ackno ledged before me this The foregoing instrument was acknowledged before me this 08
nay of 1%C , 20, by / G!/ nay of NOVEMBER • 20 _by REMBERTO BELi_O ,
woo is personally known to me or who has produced �� who is personally known tome or who has produced
i
As identification and who did take an oath. as identification who did1 take-
NOTARY
eNOTARY PUBLIC:�°° " z
„� "?�, YANELLf.AWNSO OTARYP LI Zara Tow atFlortda
• }* MY COMMISSION #FF083728 Mr Cormnhobn EE 157381
r
EXPIRES October 16. 2017 Exp&ft 011OW2016
Sign:
Print: \ a ri
Zaida
My ComLsionMy Commission Expires:
140114910017
APPROVED BY ®d'( 2na Plans Examiner Zoning
Structural Review Clerk
(Rmsed3/1212012XRevised 07/10WXRevised o6 IM009XItevised 3/15/09)