DEMO-10-1429Miami 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
FBC 20
Permit Type: PLUMBING
{opE CREW
RUG 1 0 2010
BY: ��"
Permit No.DErna) I Lin
Master Permit No.
Owner's Name (Fee Simple Titleholder)., ��C�� t, & _� �y� �t, Phone #
Owner's Address - �,13('� j i i" C: � - Jd�t j F. t1d. r
City ^'�� Y-► \; j State L. Zip 11-{(2
Tenant/Lessee Name u et C (`A t Phone # ?`� - 1 1 �-
Email c�
Job Address (where the work is being done)
q.0.1. 1 1 ,J 2tvc
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # \V- , C)LI () 1 \ _ Oa5
Is Building Historically Designated YES NO y
‘0114
Contractor's Company Name lautit, l l x
Contractor's Address 'l S C
City 1C\V y
Qualifier Name \--VA ^•
State Certificate or Regi ration No�;`�)(T Certificate of Competency No.
Contact Phone 6CI j : - C -1 E -mail
Phone #
Esc. 1�"- DC lt1
Architect /Engineer's Name (if applicable)CL
Square / Linear Footage Of Work: 1'j /30
Zip
Flood Zone
Phone # a O',] --q, -o0,111
Phone # 305 0)31
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work:
❑Alteration
g&- )0Voet T'
['New ❑ Repair/Replace1.emolition
** * * * * * * * * * * * *: * * * * * * * * * * * * * * * * ** ****Fees**********
Submittal,F,$'""Finit Fee $ CCF $
Notary $
Scanning $
Double Fee $
Training /Education Fee $
Radon $
Structural Review. $
DPBR $
Technology Fee $
Bond $
Violation date:
Total Fee Now Due $
See Reverse side -
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, BOILERS, HEATERS, TANKS and 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
promise in good fait " hat a sopy of the notice of commencement and co
whose property is s bj ct t# . ttachment. Also, a certified copy of th
for the first inspe, ti wh c occurs seven (7) days after the bu
inspection will no b: ' .v'd and a reinspection fee will be c
ated value exceeding $2500, the applicant must
n lien law brochure will be delivered to the person
notice of commencement must be posted at the job site
mit is issued. In the absence of such posted notice, the
Signature 1 ✓. ® Signa
wner or Agent Contractor
The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this
day of ! G , 20 (0, b y T O C C e _ o 1^ (`° 7 _ 0 , day oft ,t45 , 20 it) , by \Au t &Arc_. q
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
i
My Commission Expires:{
14
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign
ONDS
My Comm. Expires Aug 29, 2014
Notary Public Stat e of Fbrf
.a
:', o;. Commission •
EE 8916
" " ""'' Bonded Through National Notary Assn.
*
Plans Examiner
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
t
Commission E
YJOLnALIAL-QQ_
[illRRlS� .f�_
* * * * * * * * * * * * **
<►�� p.'•,,- ALENE EDMONDS
w lory Public - State of Florida
, y Comm. Expires Aug 29, 2014
y',�k � �- Commission 0 EE 8916
Bonded Through Natio 1 e Assn.
Zoning
Clerk checked