REV-16-2738BUILDING
PERMIT APPLICATION
❑BUILDING
PLUMBING
JOB ADDRESS:
City:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ELECTRIC ❑ ROOFING
RECEIVED
OCT 112016
FBC 201LI
Master Permit No. ,a C
Sub Permit No. 0-4:\I I la- Z-7"36
REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CO NTRACTO R
Miami Shores County:
Miami Dade
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip: �2✓ 1
Folio/Parcel#: 1 1 ' %2C) D/3-%%7) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address:
1(-7<-1(L) 04-1i)(,,./--e�. Phone#: 3/77l'
ti6 /o e) s
City: It -114I >M j
State:
Zip: 33 (
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: ) ��
City: M M 11
Qualifier Name:
4L)
State Certification or Registration #: /444&/-2
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $ Square/Linear Footage of Work:
T f W k 11Adcjir' IllAlteration El ❑Repair/Race
State: 1-t_
Phone#: 7.O SG'�
Zip: 3-3 )24--
4 t-h
2'
Phone#:
Certificate of Competency #:
Phone#:
State: Zip:
ype o orI I Demolition ��y�
Description of Work: 1� V ( C'4•) pikIn r s r� k4 ' 0)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ [J . w CCF $
Scanning Fee $ • (Al Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ k ) - GO
•
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 / posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the • •s� a �� ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OW ER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Vday of a% �2-- , 20 1-6 , by 7.('(�4jday of ) - ' ., 20 / 1 , by
6 L- i\J N -1)Q r , who is personally known .1F / l�l� , h is pkn�
personal! rLnra-t3
me or who has produced T-LTb�\J i -LA �C�me or who has produced as
identification and
NOTARY PUBLIC:
did take an oath.
Sign:
Print: C(
Seal: Y Pti4c,
Notary Sindia Alvarez
Stateic of Florida
My Commission FF 156750
o of Expires 0910312018
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
/41' 40 A JCIA L VANDAMA
MY COMMISSION # FF 028557
if/ EXPIRES: October 18, 2017
RA. h'• Bonded Thru Notary Public Underwriters
1
*******************. **************************************************************************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner Zoning
Structural Review
Clerk
/E.
RICK SCOTT, GOVERNOR
LICENSE NUMBER
f -CFC1426173.
The PLUMBING CONTRACTOR
Nan edwbelow IS CERTIFIED
Under the provisions of.Chapter489-FS.
Expiration date; AUG 31, 2018 -
LJ 11\c.n ncmc
STATE OF FLORIDA
DEPARTMENT OF BUSINESS`AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD•
KEN LAWSON, SECRETARY
1 O
',�; olAz, DaviD
---/D..8(D-PLUMBING-CORP
' _3890, Nyv-2 TERRACE''.
MIAMI— FL 3�31� 6 -
•
' . . � d '\\
N.
low
4
4
b.
...s,_\ .'t''�. 4 't` 1 4..1
1 '44} 4
+ 1
ISSUED: 06/30/2016 DISPLAY AS REQUIRED BY LAW
SEQ # L1606300000704
ti
007524
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOTA BILL - DO NOT PAY
5268586
BUSINESS NAME/LOCATION
D & D PLUMBING CORP
3145 SW 19 ST
MIAMI FL 33145
OWNER
D & D PLUMBING CORP
Worker(s) 1
RECEIPT NO.
RENEWAL
5505483
LBT
EXPIRES
SEPTEMBER 30, 2017
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
SEC. TYPE OF BUSINESS
196 PLUMBING CONTRACTOR
CFC1426173
PAYMENT RECEIVED.
BY TAX COLLECTOR
$45.00 07/13/2016
CREDITCARD-16-040048
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder's qualifications, to do business.= Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on alt commercial vehicles - Miami -Dade Code Sec Sa-276.
For more information, visit www.miamidade.govltaxeollector