PL01-1002CONTRACT
Name y ' y06'47--
Address
/ OR
Name ,, C
, 'v fr''C
/-4 05 € P
!�-C�"
License No. i,�Q
/ (7�
Repair
Address
/ /9s X /
Alteration Interior
57:
r/1.
Telephone . x07 3 Fax
Relocation of Structure
Qualifier Name s
3 ... ‘ 8
PROPERTY OWNER
Name y ' y06'47--
Address
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
/0 /1 ' . 9/51-. - tie.
Address (/ /� r� cQ Apt.
Folio Numbe 'r 3 o� ' 0 CPO COO O
f
mot Block
Job Address:
Subdivision I/ PC/ PB PG
Current Use of Property 4A -5 / 00
Proposed Use of Property 5 b0/
Tenant Information
PERMIT TYPE (✓ )
Building
Etectrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
1
e /7 4 Subsidiary Permit No.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
P Master Permit No. 93 ki 3
porn/ 5 ,(4,426.5 ,C,L . 3'3/ 36'
City State
Description of Work 0 / -00 ` -PL// a 7 t ��
Zoning Linear Feet
Square Feet Units Floors
Value of Work
Tax Assessed/Appraised Value
Flood Zone
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Bldg Value
A-54
PERMIT APPLICATION
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ OTHER
(Specify & Attach)
PERMIT FEES
S_ob
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
(sq.ft. = x/1000
x t.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ U ._ D D
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http:/ /www.miamishoresvillage.com