SGN-13-2358 Miami Shores Village
3�
p�. Building Department OCT i
3 10050 N.E.Znd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 -------
1 INSPECTION'S PHONE NUMBER:(305)762.4949 u o
FBC 20 1
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. N) sy
Permit Type: PLUMBING CANCELLED
JOB ADDRESS: Z 10 Z ��
City: Miami Shores County: Miami Dade
Folio/Parcel#: 1 \ - -za Oho ` 61 - QS S c)
Is the Building Historically Designated:Yes NO Flood Zone:
511bR/�� P,- 4D LLC-
OWNER:Name(Fee Simple Titleholder): Pl )In e—/Q &A ,ai z Phone#: -1 p:(,, ZQ d Bew5
Address: 0L�3®` f%_3 F 2— nr 1- AO e_.,
City. /'-A , rA M;
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 s ed for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR C� IONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is W- 6u and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
A�s
"WARNING TO OWNER: YOUR FAIL- TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPER . 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 approved and a reinspection fee will be charged.
Signature � Signature
Owner o A t Contractor
The foregoing' ent was a knowledged before me
this The foregoing instrument was acknowledged before me this
day of ( � ,20 ,by PN 0 ��t� I��A� . , day of 20 by ,
who is personally known to me or who has producedF=C. who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
-)'NOTARYPUBLIC: ;ot ""moo d�`./;A+�I�;�O�S P. NOTARY PUBLIC:
XPIRES It
Issir
Sigz Sign:
Print: , Print:
My Commission Expires: ? � ys`�, CARLOS P.BLANCO
l-` My Commission Expires:
�• '� MY COMMISSION.#FF033427
EXPIRES July 9,2017
e lee.com
APPROVED BY v r3 +' Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09)