DEMO-13-2181
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 10S0 4 1L iv and PtiOn vied
City:
Miami Shores County:
Folio/Parcel #: { I - t f ( -0D4Q —0010
FBC 20
Permit No.
Master Permit No.
LLJ
ByeVie. oc... w __me�eeem
air
Miami Dade
zip)
Is the Building Historically Designated: Yes NO X
OWNER: Name (Fee Simple Titleholder): j p6 w )11C-
Address: F• D •BCC 073 $ a ➢ rJ
City: 7""Cd..l 1' � State: 1� A
Tenant/Lessee Name: NIA - ' - _ e
Email: �aa.Y6�urc r D r`VY ac
Flood Zone:
rnanNitYii rnern6Z4e
Phone#:
Phone #:
Zip 903/
CONTRACTOR: Company Name:lizeci A VI i ? T- Phone#: Ci*a 416 ° (0443
Address: ELa5 lvtIA> --
City: CAD olPAr trA State: 19 .�I/
Qualifier Name: 5 rho, 1511 . QLA Phone#:
State Certification or 1Registration #: C.. C) % \i 47 Certificate of Competency #:
Contact Phone #qa�'t 916 1911-k45 Email Addressh RACt.9)1"k2lir 3rICt
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 3 a> ° Cii Square/Linear Footage of Work:
Type of Work: ❑Address CIAlteration UNew URepair/Replace ❑Demolition
Description of Work: ciat,p O P Lings
********* ***** * * ** * ***** ********* *** **Fees **** *********+ axe* * * * * * *x°*** ******* * * * ** *** * **
Submittal Fee $ 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 $ '1(20
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, BOIT FRS, HEATERS, TANKS and AIR CONDMONERS, 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 wily -. e ap• d and a reinspection fee will be charged.
Signature
weer or Agent
The foregoing instrument was acknowledged before me this y +�
day of b , 20 (3 , by �, b� t - (rlcz 54.,P -n') i
who is personally known to me or who has produced a ekr
As identification and who did take an oath.
NOTARY PUBLIC:
Signature %52-d-e- C.,544--gAdN-
Contractor
The foregoing instrument was acknowledged before me this
day of jo-y1 , 20 /3 , by CA S-e. 1 S 14,01 ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
c
Print: n :-(tea 3- \ /c e d 3 Print:
My Commission Expires: JT 3 I / c O (y My Commissi
, fl 331 3 1
APPROVED BY
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
CERTIFICATION
Please be advised that New Spring, L.L.C. is a limited liability company organized under the
laws of the Commonwealth of Virginia. Please be further advised that Abbas Ghasse1Di (also .
commonly known as Abe Ghassemi) is the Sole Member of New Spring, LLC and retains all
management, control and authority over the maintenance and operatian of New Spring, L.L.C:
The undersigned Sole Member of New Spring, LLC hereby certifies that the above is true and
accurate.
1 A1701.3
Abbas Ghassemi, Sole Member
New Spring, LLC
City /Cowalyd 6r
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