PW-16-1541i /liami 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
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FBC 20I
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BUILDING Master Permit No.V — (1-2—t(
PERMIT APPLICATION sub Permit No. 1 t<)L . - /t
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL
❑PLUMBING ❑ MECHANICAL ElPUBLIC WORKS CHANGE OF D CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
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ECEIVD
AUG 2 8 2017IL
JOB ADDRESS: J% s 6 -
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO X
Flood Zone: BFE:
Occupancy Type:
Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder): RIGHT OF WAY
Address:
Phone#:
FFE:
City: State:
Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: TECO PEO Phone#: 954-453-0806
Address: 5101 NW 21 AVE. STE.
City: FT. LAUDERDALE State: FZip. 33309
Qualifier Name: JESUS VEGA
Phone#: 954-453-0806
E1608
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ 1000
Type of Work: ❑ Addition ❑ Alteration
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: PERMIT RE -NEW FOR A GAS SERVICE LINE
Specify color of color thru tile:
Submittal Fee $50 . O� Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)