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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No.t olOQU -- (n5
Master Permit No.
Permit Type (circle). Building Electrical Plumbing Owner's Name (Fee Simple (/ _ i e wider) /e 'cM? P, �1??2/2 3S 5 Phone # ysg 66.) S ?2
-
Owner's Address E3 J ° / T°4(P!,fA Av ROQ �t"CityJl4.�'fi,1 (9 State TJ19�'iZip 33 1 3 S
Tenant/Lessee Name
Phone #
Mechanical Roofing
Job Address (where the work is being done) g So ii V r0 ,P2 AY PUn¢
City Miami Shores Village County Miami -Dade Zip 3 3 / 3 8
Is Building Historically Designated YES NO /'C
Contractor's Company Name 0e'elide t1 Phone # 30-6 773 9 S 3
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Pirmit,4 eX2e2 Square Footage Of Work:
Type of Work: ❑'A['Addition['Alteration['New❑ Repair/Replace ❑ Demolition
Describe Work—' KQ Tt\NrCi F001 1 c -_ (_� J
1
C. Q.
****************************Fees******************************
Submittal Fee k``, O . w Permit Fee $ / 50 —
Notary $ "5- -- Training/Education Fee $
Scanning $ 3 Radon $ `—"'—
Zoning
CCF $ 3
Technology Fee $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ ` LC/ 1_5
(Continued on opposite side)
CO/CC
3•5-
Bond $
taalMiami Shores Village
i:Ara zdpa Building Department
N 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No Pa4OU' (�5
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type (circle). Building // Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple_ i e'older) (//e,69/2 P Ole ,0%% Phone # 30 Y-SO 6 d� S
Owner's Address J ° / , U Road
/�l4.J�fi1
City ' 7 state J�/Del °ltiC._ zip 33 l 3
Tenant/Lessee Name Phone #
Job Address (where the work is being done) g £ So t' r01P?4 Pc 41
City Miami Shores Village County Miami -Dade Zip .3 / 3 S
Is Building Historically Designated YES NO
Contractor's Company Name oC Phone # 3-5 77 3 _J 3 3
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
t! ..JJ
$ Value of Work For this Pbrmit, )OIiSquare Footage Of Work:
Type of Work: DAddition^DAlteration [New w" ❑ Repair/Replace ❑ Demolition
Describe Work Q --� Q Tt'[r fool cent__ I glCl ^�l
e_Q.
****************************Fees******************************
Submittal Fee $C) . 00 Permit Fee $
Notary $ 5
/ `�-o—
Training/Education Fee $
CCF $ 3 """ CO/CC
Technology Fee $ 3 7 c
Scanning $ 3 Radon S Zoning — Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ L LC/ 1 5-
(Continued on opposite side)
Date
Type Insp'n
Permit No.
Name
inspeScnoy.xeyuesiTat M-56-U-');$
�
31POV---.45
\ft OliC1
Address 55D i° l? /0 (7
17-
Company
Phone # %
Inspection Date
Correction
Re-Insp'n Fee
0