20-1613 Permit Application 08032020_v1(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No.___________________
PERMIT APPLICATION Sub Permit No.___________________
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF
CONTRACTOR
CANCELLATION SHOP
DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes ______ NO
Occupancy Type: ________ Load: _________ Construction Type: ___________Flood Zone: ________ BFE: ________ FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work:
Specify color of color thru tile: _____ _______ ___
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
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561 NE 106th Street
11-2231-014-0140 x
R-3 N/A N/A N/A
David & Angela Benjamin 305-332-3812
561 NE 106th Street
Miami Shores Florida 33138
davidbenjamin7@yahoo.com; angelafbenjamin@hotmail.com
Owner-Builder
Victor J. Bruce (305) 310-5030
370 NE 101st Street Miami Shores Fl 33138
120,000 +/- 789 sq. ft.
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1) Addition of Master Suite with bedroom & bathroom; 2) Garage Conversion into Laundry
& Walk-in-closet; 3) New Terrace & pool (under separate permit)