BP-04-379Miami Shores Village
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Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tpl: (305) 795.2204 Fax: f305) 756.8972
BUILDING
PERMIT APPLICATI
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder)
Permit No. 6 ? 3 19
Master Permit No.
Electrical Plumbing Mechanical Roofing
Oeqoi
Owner's Address 611 is >J (Z 4 A1/2').AA; (Le)Ar>
Phone #
CityY✓J rbcont S 1-4 agi State (L Zip 1'3i 3 6
Tenant/Lessee Name
Phone# 3vr '773 - 9ers3
Job Address (where the work is being done) k' �' Z-f qv- jrv'
City Miami Shores Village County Miami -Dade Zip 7 3 1 ?
Is Building Historically Designated YES NO
Contractor's Company Name c)2,0-1,...); t LSC
Contractor's Address 14040 lat.) (c) C,-t
City .0 . t'Y1►'Orn State F-t.
Qualifier C 2.LQ NSDI, �A
Phone # C —
Zip '2,j (o '
gineer's Name (if applicable) 1/-i pram- A- f,As t('1J £1..L Phone # 3 0 S--'7 Sal-Z 3, G
$ Value of Work For this Permit
Square Footage Of Work:
Type of Work: DAddition jr`Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: F PANT D ) "' 4 Pyri,. VT) 4 -GK.. Avvv S'7i'V2' 'rq3 iD-C4k 'f /4.44
Cob evc cre:AO✓1 i Pf A-'n'r
****************************Fees******************************
Submittal Fee $$ Permit Fee $ 13� CCF $ r O4
O CO/CC
Notary $ Training/Education Fee $ 0 A I 00 Technology Fee $ 7,
Scanning $ la — ' Radon $ ..---7 Zoning Bond $
Code Enforcement $ Structural Plan Review. $ So ' 0 0
Total Fee Now Due $ . 711 S 0
(Continued on opposite side)
41co_coo c S201(
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Inspection Date
Approve ==.-
Correction
Re-Insp'n Fee
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Date
ect
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Type nsp n
Permit No. tEPoLL
Name Of3SO
Address
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Company
Phone #
A I 5
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102-2a)
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Type Insp'n
Building Inspection Request .��p
Date °"� �`. 5.1°°
64
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Permit No. o '�'��c.
cA 12
Name 'Or„'�'Q �r� ti—•
Address 557) [" � � ° CI°
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Company
Phone # -
Inspection Date
Re-Insp'n Fee
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