PI-14-759 Miami Shores Village APR j,S
Building Department BY V;;V;;
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762A949
FBC 20
BUILDING Permit.No.
PERMIT APPLICATION Master Permit No. _ 77
Permit Type:PLUMBING
JOB ADDRESS: 89 NW (06 511r W 5 -FL 3 31Sc7
City: Miami Shores County: Mie Zip: 3 51 S O
Folio/Parcel#: 11 — 213(o — 0 O(a "O 1 -'y
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Cy i I Ime-M® ALMA,.PA Phone#:
Address: 89 rJ Vj 10(01" 5-tre.C�
City: '5 Nth(zC S State: F(.0 it l 1:>A
TenandUssee Name: Phone#:
Email:
CONTRACTOR:Company Name: 131 LIEN T_N)c • Phone#: 30S 6- 2(0 59
Address: 2 O 2 O O N V►] Zryd AV C . '0"' L)i fie 4 O Z
city: W i A.r-11 e4fZ7E ka.S _State: F L4 mt CSA, Zip: 33 t(601
Qualifier Name: TZQ V5e1r_7V ? _V-0-M Phone#:
State Certification or Registration#:r FG 14 Z b 8 C(q Certificate of Competency#:
Contact Phone#: .305(o-'-1 Z(go 501 Email Address: LCD 0 b.ko►n'to�r• nom"
DESIGNER:Architect/Engineer: Phone#:
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Type of Work: ❑Address ❑Alteration ❑New gRepair/Replace ❑Demolition
ruc
u COs7
Submittal Fee$v V Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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. °
64WARNING TO OWNER: YOUR FAILURE`�TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
BIPROVEMENTS 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 nM
and a reinspection fee will be charged.
SignatureSignature
Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged be re me this
day of _,201 ,by day of 20 ,by A d
who is 2gw%a4rk0W1no me or who has produced 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.
NOTARY PUBLIC: NOTARY PUBLIC:
Print: 054428 pin. Y PEZ
My C1(407)
xpir�sXPIRES January 11,2015 My C :f' MY COMMISSION#EE054428
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(407)398-0153 FlwklallotarySe�rtoa,00m
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APPROVED BY � Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07OWvised 06/10/2009XRevised 3/15/09)