PL-14-2249 Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 h - -- -
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. Z2
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL []PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ?v ( /V '� / ? ���C-C'.('J'
City: Miami Shores County: Miami Dade Zip: 33
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: /Flood Zone: BFE: FIFE: ,,//
OWNER: Name(Fee Simple Titleholder): R 1.4 (( j Phone#: 807 - 7d V5—
Address:y� y-
City: State: r L Zip: 331
Tenant/Lesseee Name: Phone#:
Email: l O� /�P C0 m
CONTRACTOR:Company Name: FA) rn 6 /h .5 feRhone#:
Address: 3n 2. N l) 1,25-3-/
City:_� PALL,) k,+ State: f'l0 r)G{ A Zip: 3 3 OJ V
Qualifier Name: PCJo -gC OZ T( Phone#: / — 730
State Certification or Registration#:0 "�. f y�t�a-� 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ o Square/Linear Footage of Work: 0
Type of Work: ❑ Addition ❑ Alteration ❑ New R Re air Re lace
/ p / p ❑ Demolition
Description of Work: -e ! a v LS /
I- �-o el., Pcg 0 m CU--)
.4 w0--estt� �
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ z CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,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 a sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
r
Signature / Signature
_ P/
OW or AGENT CON OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
dayof 20 7 by l U day of 20 ` 7 by
W r O who is personally known to ?0/2.y ��c H+� ^� whn is opr onally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY IC: NOTARY P C:
Si n: 'Q //�"✓
g Sign:
Print: 1 G1 Print: \
;..•SppY P�j".•
e<,. RICARDOIRIARTE
Seal- Seal:
Seal: _ °
a° 1( e`er: RICARDO IRIARTE _€ MY COMMISSION#FF088736
MY COMMISSION#FF088736
o. '.'FeFop EXPIRES February 2,2018
EXPIRES February 2,2018 (407)398-0153 FloridallotaryService.wm
6W9Gk***ilbotft*# I�e�`oV*** *********************************************************************
APPROVED BY � i <<?�r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
CFC 1426257 ISSUED: 05/29/2014
CERTIFIED PLUMBING CONTRACTOR
GUZMAN.PEDRO S
PSG PLUMBING SERVICE INC
IS CERTIFIED under the provisions of Ch.489 FS.
Exp--4-:AUG 31,2Q16 14062900M740
RICK SCOTT,GOVERNOR LL __ _
KEN LAWSON,SECRETARY
STATE of FLofWA
DEPARTAUNTcoNs l '�AM ` ► BION
CFC1BOAftD
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The PLUMBING CONTRACTIOR
Named bebw IS CERTIFIED
Under the Pmvi lbm of Chapter 489 FS.
EVkW ion date: AUG 31,2016
GUZMAN.PEDRO S
PSG PLUMBING SERVICE INC
343 NW 96 ST
MIAMI FL 33150-1939
ISSUED: 0&2VA14 DISPLAY AS REQUIRED BY LAW
SEQ 4 L7 749