PL-10-1894 Miami Shores Village na
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 BY: ,,,J..::°.,•.°'••°°° °I°
BUILDING Permit No. �—t—
PERMIT APPLICATION Master Permit Nof-C", 10_1K911_z_
FBC 20
Permit Type: PLUMBING f /''
Owner's Name(Fee Simple TitleholderJLt 4 WI(j p fl' ,e yj, Phone .3,0§)4pi
Owner's Address C LO 1 — �e_f
City 0j(_4 fNL c State &Y( Zip S
Tenant/Lessee Name Phone#
Email T Ad rl Y 6.64 m 41 fcL it
Job Address(where the work is being done) 12 ff- 11AL) �C) KIl- � �' C4
City Miami Shores Villaee County Miami-Dade
FOLIO/PARCEL#
Is Building Historically Designated YES NO Flood Zone -TO
Contractor's Company Name Phone#
Contractor's Address
City State
Qualifier Name NPh
Z4 r7h-
State Certificate or Registration No. Certificate of Competen No.
Contact Phone E-mail
Architect/Engineer's Name(if applicable) Phone#
14 0
Value of Work For this Permit$ 14.0 d• a 0 Square/Linear Footage Of Work: (DO
Type of Work: ❑Addition ❑Alteration ❑New
❑ Repair/Replace El Demolition
Describe Work: roa 2
t-0- e -� I.cv e
rte `
Submittal Fee$ Permit Fee _570CCF$ CO/CC$
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Bond$
Double Fee$ Violation date:
Structural Review. $ Total Fee Now Due$
See Reverse side–> �
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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 is issued. In the absence of such posted notice, the
inspection will not be approv d and a reinspection fee will be charged.
Signature Signature
wn or Agent Contractor
The for of instrument was a o ledgeedrbefore me thi The foregoing instrument was acknowledged before me this
day oM '201(3,by '`� day of 20_,by
o is rsonally known to me or who as produced who is personally known to me or who has produced
-3 Qentification and who did take an oath. as identification and who did take an oath.
NOTA PUBLIC: 0 .NOTARY PUBLIC:
s
Sign: CA Sign:
Print: q� Print:
%My Commission Expires: , My Commission Expires:
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APPROVED BY l Z l d , Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07)(Revised 06/10/2009)