PL-13-1396 Miami Shores Village =916XI
D
Building Department 203
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (3057 762.4949
FBC 20 fv /
BUILDING Permit No. �" I l I (
PERMIT APPLICATION Master Permit No. P.---, 2 S3
Permit Type: PLUMBING
JOB ADDRESS: 13-9- N j -e
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: L t — Z 13(dzp, 00'9 e Q9!?j
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): L UC Phone#: f,0k'-1 C?3Ct
Address:(- %A Jt- 37(Z44C-_
City: i�c� State: 1,OrZ41JA Zip:
TenanV*Lessee Name: NJ lmv- Phone#: iN-
Email: fes/r4 V W`-% e_0VV-\
CONTRACTOR:Company Name:
Address: Zo l/l/y S A l/
City: Sta �'La&� Zip: 33)3
Qualifier Name: � t Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: 5I riZ:TyA 3 Email Ad
DESIGNER:Architect/Engineer: 1 Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New JdRepair/Replace ❑Demolition
Dgscription_ofWorkl-. 1yP/-a0 <Ae N4 r_1 !( 1 t.1-0 eeizer
Submittal Fee$ ermit Fee CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Do , le Fee Structural Review$
TOTAL FEE NOW DUE$
F
Bonding Company's Name(if applicable)
Bonding Compi6y'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 certied 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.
9
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The fore �,mg instrument was acknowledged before me this S
day of ,20,(,�,�by 'E— T 5eex 20�,by',g'eP.rt4N QQevKD-x,vi
who is ersonally known to me or who has produced '`✓ o is personally known to a or who has produced
As identification and who did take an cth.`'' M* as identification and who did take an oath.
z �•. w
NOT PUB r NOTARY PUBLIC:
Sign• Sign: ffe /
Print: f lie 11611�� Print "�c.
My C srPol ` E. CASTELLANO My ""'SonP IrASE. CASTELLANO
�•` MY COMMISSION#FF001595
;. Qr -XI
r MY COMMISSION#FF001595
?�Foyo? EXPIRES March 21,2017
q�..........'Q,�
FOFF°.• EXPIRES March 21.2017
(4071398.0153 FlorldallotaryService.eom
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APPROVED BY IG'� 'a ®` Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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