DS-10-20-2293Miami 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
FBC20
BUILDING Master Permit No. 2=011-ZLJIZ K
PERMIT APPLICATION Sub Permit No. 6— 1& ZO 1, 2013
Bl ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
(/❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFF�E:
OWNER: Name Fee Simple � > >
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Address:
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City: \ State:
Zip:
Tenant/Lessee Name:
Phone#:
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CONTRACTOR: Company Name:
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Address:
City: G" S``tat :
Zip:
Qualifier Name: / ' `�
Phone#:
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State Certification or Registration #: (��C 5
7�- - 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 ❑ Re air/R place ❑ Demolition
(❑
cription of Work: �— S
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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 $
(Revised02/24/2014)