EL-04-22641
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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 Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address S .5 & A/Z.
City %1 /Met ` SL, 0✓ State
Tenant/Lessee Name
1°474ar•
l0/ f74
Permit No. .. V-.)?
Master Permit No.
Plumbing Mechanical
Roofing
Phone #
Zip
Phone #
Job Address (where the work is being done) $St /fie / O / S�
City Miami Shores Village
County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name g.,/:,-;;;‘,1-�L°�7"J`<c,
Contractor's Address 2D D / SW . -a Sy r_ /1/
City z`o State
Qualifier 9 i7"-ee •9'
Zip ,.7_13/ef
Phone # f 1-9761
Zip
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit t
Type of Work:
Describe Work
Square Footage Of Work:
DAddition 2Alteration ONew i .'+. Repair/Replace. ' ; 0 Demolition
r -// , e i•✓ /o u o / f' ' /46- e/ 0.454 4/�.D'c4. ;fe P,4,-
Submittal Fee $
Notary $
Scanning $
Code Enforcement S Structural Plan Review. $
Total Fee Now Due $
•
Permit Fee $ /✓ ' ow.
Training/Education Fee $
Radon $
CCFS A00
COO Technology Fee $
Bond $
(Continued on opposite side)
uiici g inspection tcequesr
Date
Type Insp'n
Permit No.
Name
Address SS C.) � ao 10
rci (OCh"
o(4 -aaG
Company O{'JtYY) i T"C_ 0.)
Phone #
Inspection Date
Approved
Correction
Re-Insp' n Fee
2 62
1 3 4f4
C *ea ee„ ro
0
B3uildin : Inspection Request
Date
Type Insp'n
Permit No.
Name
Address
Company
Phone #
e„,
-az/
0
S€O N/0/ S2r
95-170 "-4.2
Inspection Date
Approved (73,91),
Correction ❑ �'����.%
Re-Insp'n Fee ❑
(17101,10-474- cPig--4y0