PL-15-1665 . ' , Miami Shores Village P' I �Ufliiri id@(1ti
t� 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
v u� ; trtlt�as APRT
z Phone: (305)795-2204
�wxmA r3 y ��su � �' Expiration: 02/03/2016
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Project Address Parcel Number Applicant
10050 NE 12 Avenue 1132050190370
Miami Shores, FL stock: Lot: BEYOND ALL REVOCABLE TRU
Owner Information Address Phone Cell
BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue (305)244-2356 (786)709-3909
- --- - --- MIAMI SHORES FL 33138-
10050 NE 12 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
ROSMEL POOL INC (305)592-7900
w_ ... _ ......_ _ _...._... _.. Total Sq Feet: 00
Type of Work:POOL PIPING Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Main Drain
Bond Return: Final
Classification:Residential Scanning:3 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# PL-7-15-56212
$3.38 08/07/2015 Check#: 12936 $ 193.96 $50.00
DCA Fee $3.38
Education Surcharge $0.40 07/06/2015 Check#:12874 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $243.96
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore,I authorize the above-n d contra r o do the work stated.
Z August 07, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent ate
Building Department Copy
August 07,2015 1
Miami Shores Village I C E I V E D
JUL 0 0 2015
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 --
BUILDING Master Permit No. P
PERMIT APPLICATION Sub Permit No.
7❑ ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION r-1 RENEWAL
PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I _� O N� L Z- ' "Er
City: Miami Shores County Miami Dade zip: 3 3435
Folio/Parcel#: i 1� 3 Z®5 t°I - 3 ® Is the Building Historically Designated:Yes NO �
Occupancy Type: Load: Construction Type: Floodone: 8FE: FFE:
1931rlre-s v'
OWNER:Name(Fee Simple Titlehoider):� Ld A&& f-E uG�ie (/L VJPhone#:_J0 2-,,(Z 3S-(o
Address:__ S EA-SK
City:N09AN IIbMy, kXpe State: `C L Zip: 3311f I
Tenant/Lessee Name: L7 Phone#:
Email: e(- b • ��
CONTRACTOR:Company Name:�C,v,-e1 Phone#•
Address: %)yS `4 OA, b(p S Sun
��
City: , )r)"O, I State: Zip: 3 l(00
Qualifier Name: i AhA kla 1/ l Phone#
State Certification or Registration#: C a i L451e 90q Certificate of Competency#:
DESIGNER:Architect/Engineer: LA✓1 C! "i ' t �� j `� I�/� aj Phone#:__ � �— >7 qS
Address: I3AA k n 4a 7( efr-v-
City: W n1y.L Stater Zip: 1"l
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: , 0 �D In C�
Specify color of color thru tile: 1
Submittal Fee$,"I Permit Fee$ YI� '��2� '�y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revlsed02/24/2014)
Bonding Company's Name(if applicable) f I•A
Bonding Company's Address I�
City State Zip
Mortgage Lender's Name(if applicable)_ Q f-eq
Mortgage Lender's Address I
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 certlfled copy of the recorded notice of commencement must be posted at the Job site
for the first InspFn occ se v (7) days after the building permit Is issued. In the absence of such posted notice, the
Inspection will nopprove d d a reinsp ction fee will be charged.
r
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
a day of ��t;+�� 20CS .by day�/of `y)y1AE! _ ,20 15
T%erg-e S1 rAVay;6%who is 1sonally know o who i ersonally know o
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 PUBLIC: NOTARY PUBLIC:
ASign: Sign:
Print �- +4�2�e�,®• —�4r�, Print 2
Seal: iUZn ° Seal:
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;R' eCOPflk41SSIG+d#FF01905 � r n�COMWIISSP:]#FF 01905
LhPIRES: P,4AY 19,2017 0 t.P'.RE:. ' X19,2017
APPROVED BY 7- 7./-5 Plans Examiner Zoning
Structural Review Clerk
(Revlsed02/24/2014)