REV-16-2651 ami Shores Village FCr
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Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY --
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. 1`C- ro— 9 S
PERMIT APPLICATION Sub Permit No...�V I�'��)
❑BUILDING ❑ ELECTRIC ❑ ROOFING W REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
1 �^ p CONTRACTOR DRAWINGS
JOB ADDRESS: ! D 3 D J IU 2 Ave-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): YYl YS- 8017hie yuM 6)a wdjalu Phone#:
Address: 16 305 N- E, 2 AVe
City: Ml 0,VLA� �Ne S State: F Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Y e?S c o rocJ Phone#:, US a S
Address: Lk) onu', a'
City: ih i G VV-��^i State: F t Oy-i c{ A- Zip: 3 31 S`7
Qualifier Name: t1`i Q t jy A2-Q Ue 2- Phone#:
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State Certification or Registration#: G�C I ( 2 '� (OAO Certificate of Competency#:
DESIGNER:Arch iitect/Engineer: Tose A)Lai4jy" e-7 p € Ci V t i 4 S�Yue4 r,rg-[ Ftia. Phone#: 36-. "
Address: t -1 E-6 S4 S red SQ*�+< 1- City: &kaj�.A State: Zip:33 0/6
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of Work:T-ella; �►�n�,,tic�2_ Ty", klPau kji� SyFFi-- -31p e✓i dewi,_,
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ �� CO/CC$
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Scanning Fee$ -/ Radon Fee$ �— DBPR$ ..®"' Notary$
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Technology Fee$ -J Training/Education Fee$ �— Double Fee$
Structural Reviews$ ?'Q Bond$
TOTAL FEE NOW DUE$ ZO"'1
(Revised02/24/2014)
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NOTICETO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
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