RF-03-20-626Miami Shores Village xEc-IVIL
BUILDING
PERMIT APPLICATION
Building Department MAR 23 P020
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
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INSPECTION LINE PHONE NUMBER: (305) 762-4949 6
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Master Permit No. �7�{— -V�' W ' +
Sub Permit No
BUILDING ❑ ELECTRIC fPl ROOFING 7 REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: BOZO d q(3z'Z WE i' AVL
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel8:IL- .3Zob- /Jlie, ) Is the Building Historically Designated: Yes NO
(eS. Occupancy Type: ILoad: Construction Type: ou Flood Zone: BFE: FIFE:
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OWNER: Name (Fee Simple m
Address: /0Z° d"Iv
City: &,(il, r 117 e ✓K� State:
Tenant/Lessee Name:
Email: �1
CONTRACTOR: Company Name:
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Qualifier Name:1/1i/Q///-e /4AZ4�l1" Phone
C. State Certification or Registration M eC /?zL z_" L Certificate of Competency#:
DESIGNER: Architect/Engineer:
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Zip: y -ro d )C
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Address: / —/1City: State: Zip:
Value of Work for this Permit: $ 11 o %G w Square/Linear Footage of Work: ,3JV 4lrp
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Type of Work: ❑
Addition ❑
Alteration
❑ New
Rep+ ir/ epi�ace� El Demolition
Description of Work:
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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 $_
Structural Reviews
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $