PLC-18-3622Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:12/07/20
Parcel Number
9050 BISCAYNE BLVD, Miami Shores, FL 33138 1132060100010
Contacts
Permit NO.: PLC-12-18-3622
Permit Type. Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/05/2019
PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant
PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC
P 0 BOX 407, LAKELAND, FL 338020407 P 0 BOX 407, LAKELAND, FL 338020407
Other:863688747 Other:863688747
PLUMBING MART OF FLORIDA INC Contractor
DAVID HIGHT
21 SE 10 ST, DEERFIELD BEACH, FL 33441
Business:9543794020 RWennet@plumbingmartinc.com
Description: REPLACE AND RELOCATE SINKS DRAINS AND ASS Valuation: $ 58,150.00 Inspection Requests:
NEW SINKS FOR STARBUCKS KIOSK
Total Sq Feet: 791.00
REPLACING EXPIRED APPLICATION
CC17-2469
Fees
Amount
Application Fee - Other
$50.00
CCF
$35.40
DBPR Fee
$26.17
DCA Fee
$17.45
Education Surcharge
$11.80
Permit Fee
$1,694.50
Scanning Fee
$3.00
Technology Fee
$43.61
Total:
$1,881.93
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$1,881.93
Check # 034873 12/07/2018
$1,881.93
Amount Due:
$0.00
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 named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor /
December 07, 2018 Page 2 of 2
r It
BUILDING
PERMIT APPLICATION
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
QPLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: 9050 Biscayne Blvd.
RECEIVED
DEC 0 6 1018
u-hC-A"
FBC 20F_+
Master Permit No. CC-8-6-Z22�'
Sub Permit No.21 18 —MCP 22
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1132060100010 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Publix Supermarkets, Inc. Phon
Address: PO Box 407
City: Lakeland State: FI. Zip: 33802
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: Plumbing Mart of Florida Phone#: (954) 379-4020
Address: 21 S.E. 10th Street
City: Deerfield Beach State: FI. Zip: 33441
Qualifier Name: David Hight Phone#: (954) 379-4020
State Certification or Registration #: CFCO 57511 Certificate of Competency #: cfco 57511
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: _
Value of Work for this Permit: $ 56,000.00 Square/Linear Footage of Work: 19700
Zip:
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Replace & relocate sinks, drains and add new sinks �rL S] V cx_- cs KI 0S �
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $ _
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
r - �
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 reinspection fee will be charged.
Signature 4
, k='
OWNER or AGENT
The foregoing instrument was acknowledged before me this
1.! -k m
day of ^L)Q.All pri J9al , 20 % by
k1I Q 1 '.!jP. r — who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY BLIC:
Sign: v l�
Print: 7dhn�.-tf UWQ�-
as
Signature
CONTRACTO
The foregoing instrument was acknowledged before me this
� h day of AJQVMbfir 20 [ % by
V d I AI1-I- , who is personally known to
tj
me or who has produced N' f} as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �i�lril
Seal: µr�u W.,w
NotaryPublic- StateofFlorida
�o DONNETTLOWE Seal: a
Commission M GG 113363
* * My COMMISSION#GO064362 `-�MyComm.Expires)un11,2C21
c� EXPIRES: December 12, 2020 °P a Sw&d through Nawat Notry assr.
�OFFI� Bmdad7hu&d�rNetavi�
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk