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EL-17-287Miami 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: (30S) 762-4949 "O"+CEIVED FEB 3 2017 BY: Vc�-( FBC 2010 C, " y Master Permit No. Pic I �-?A(o BUILDING CA R , PERMIT APPLICATION Sub Permit No. ❑BUILDING B/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL []PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION CCONTRACTOR ❑ SHOP DRAWINGS JOB ADDRESS: 41) 7 N''`� Ale 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): �� L� %7? L T7f71' Q� Phone#: Address: %GS(J�l a �� City Tenant/Lessee Name: Email: State: Zip: hone#: CONTRACTOR: Company Name: M ei✓-o -f-= I c t v t SIF, Vy t L<2J Phone#: 30 Address: frogno 1-)6 :g-0 �j� City: 0 •M i Wi i State: f�— Zip 9-3 l Qualifier Name: Q e 7- Phone#: ©,F State Certification or Registration #: £ C 1-3 005-3 Z L Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ .500 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color ofcolor thru tile: G Submittal Fee $ " 30 I9ft-AD Permit Fee $ CCF $ CO/CC $ �— Scanning Fee $ v 1 (� Radon Fee $ t DBPR $ _ Notary $ Technology Fee $ 0 v Training/Education Fee $ ' Double Fee $ Z Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014)