DS-20-374Miami Shores Village R-ECFI E-f3
Building Department FEB 19 2020
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY:
INSPECTION LINE PHONE NUMBER: (305) 762-4949 - �G ll�
FBC 20
BUILDING nn1�° Master Permit No. ���d 2- 20
PER APPLICATION Sub Permit No.
UILDING ELECTRIC [:]ROOFING ❑ REVISION EXTENSION 7RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS [:]CHANGE OF CANCELLATION SHOP
CONTRACTOR 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: BFt: FFE: ,
OWNER: Name (Fee Simple Titleholder): &C V- f Q—g 6JOAe— Phone#: 26 6,D(?
Address: J `c' I A-) E l d)0 ,94—
City:
State: 't — Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:4
Addrees'1s::, � � S� � S
City�t.0 G,1019 S ate: _
Qualifier Name: Gt'T� "t C IK
State Certification or Registration #: <f 64 157 0 t —
DESIGNER: Architect/Engineer: k 9
Zip: 33)
one#: �-? 5 C? I C? 10%
Certificate of Competency #:
Address: Ci State: Zip:
1 _
Value of Work for this Permit: $ Z: 2— —z;b Square/Linear Footage ofWork: 7�/ (o SI F
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
e— _ .'en n /? __ 1
Description of Work:
Specify color of color thru tile:.
Submittal Fee $ Permit'Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF
DBPR $
CO/CC $ _
Notary $_
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)