EL-04-123BUILDING.
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Mianu Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. RE.2004 i 23
Master Permit No. )
RECEIVED
M : 2004
Permit Type (circle): Building lectrica Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address / j 5 ke'- /o/ S'f
Aim: i State AL Zip 3).
Tenant/Lessee Narii- . Phone #
Job Address (where:thelwkirk is being done)
City &Hami Shores Village
s's"? )t-/t/f/
County Miami -Dade
Is Building Historically Designated YES
NO
Zip 33/3,
Contractor's Company Name / '4,f� b%? A-, .''C Phone # /3Y76 rig
Contractor's Address 2 c), / 5-1,/ J—/L/
State tr Zip }j?/f
Cityv-r
Qualifier �: .� -�/ o, -,-e c 4
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Type of Work: DAddition eration
Describe Work: if4..if e_
/4o < <"rd/1/ 11;16 Ste✓
Square Footage Of Work:
/ ❑New / 'J❑ R�[epair/R p11acce �I❑ Demolition
f °k 14 e..J c� . �l C T�.S I.5,iii 7 41/. i" 4Tr.�G/
9� 9/��s
cr 1.
Submittal Fee $ 50 , 00 Permit Fee $ /O a • o®
****************************Fees* ***** ********************* es•
CCF$ /,ja
Notary $ Training/Education Fee $ . D Technology Fee $ o rc
Scanning $ c'3 0 Radon $ Bond $
Code Enforcement S
Total Fee Now Due $ 5 t 1)
Structural Plan Review. $
(Continued on opposite side)
Building Inspection Kequest
Date ��[ef
Type Insp'n gal)�-'
Permit No. G�- U`f'- / 3
Name v i Citi/L)
Address 556 /44 6 i o I sT
Company Vk4d 1E'+vie.
Phone #
qs-q - -16:8 C'q �
Inspection Date ic°1'k//°°.
�/
Approved d L�
Correction C73
Re-Insp'n Fee ❑
• Building inspection xequest
Date 5 1,17
Type Insp'n P�yh0I UJOI! O h
Permit No. 67 l .001F123.
0-€00ff--
Address 5 S o t Ok 34--
Company h ne)/IZCP
Phone #
Name
Inspection Date 5/
Approved
Correction
Re-Insp'n Fee
0
29/4-raery
H if )-•/ 0iIe"-',"4 �r-i