PL-15-1540 Miami Shores Village JUN 2
Building Department - ---
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION UNE PHONE NUMBER:(305)'752-4949
FBcaole-
BUILDING Master Permit No. C-1 j._ yLi
PERMIT APPLICATION Sub Permit NoR,1 5--1 Sy6
❑BUILDING ❑ELECTRIC ❑ ROOFING REVISION ❑EXTENSION ❑RENEWAL
OPLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑CHANGE OF ❑CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 165 NW 92 Street
City: Miami Shores County Miami Dade Zia
Folio/Parcel#.11-3101-033-1000 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee simple Titleholder):Wells Fargo Home Mortgage phone#:(561)988-9622
Address-410`1 WISEMAN BLVD
city: SAN ANTONIO State: Zip: 78251
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SUPERIOR PLUMBING AND AIR G Phone#: (561)241-2822
Address: 6600 W ROGERS AVE SUITE 9
City: BOCA RATON State: FLORIDA Zip: 33487
Qualifier Name: WINSTON T. PEARSON Phone#: (561)699-0075
State Certification or Registration#: CFC 1429129 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 't(®y•.o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of work: PLUMBING REPAIRS NECESSARY TO BRING HOUSE TO CODE 0
Specify color of color thru tile:
Submittal Fee S Permit Fee S CCF S CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology fee S Training/Education Fee$ Double Fee$
Structural Reviews Bond$
TOTAL FEE NOW DUE$
(ReviseM2/24/2014)
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 absence of such posted notice, the
inspection will not be approved and a relaspection fee will be charged
�AADLEV W.,➢ENSEN s
Signature Oifil®OCUIiIentafo°t Signature w
OWNER or AGENT CONTRACTOR
The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of .20 NT ,by A t day of LA-1 20 1,5--1
.5--1.by
�/Y✓1� .who is personally known to �✓ "r +� r who is personally 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 to
NOTARY PUBLIC: NOTARY PUBLIC: ;�,�: i; ERTO RIVERA
MY COMMISSM 0 EE148
EXPIRES Nwrenrbet 22.2015
Sign: 31gn:
Print: S®RI Print:
Seat: Commission Number19641
My Commission Expires Seal:
°
May 14,2016
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Rev1sed02/24/21114)