1220 NE 94 St (8)STATE OF FLORIDA,
COUNTY OF DADE. ss
Disapproved
(Signed)
MIAMI SHO
ES VILLAGE
BUILDING INSPECTION DEPARTMENT.
A PUCATION F` R =-U LDING PERM8T
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address ...... (" 242-'
Registered Architect and /or Engineer
Name and address of licensed contrpctor
Location and legal description of lot to be builfon:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Da¢e..._... _. _.._._._ .._.... ,1B .'
_ No .....
7...�i._7.
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such (ubcon• ctors, on wgrlr to be performed under this
pennit, as are licensed by Miami Shores Village. I
r _
Remarks (Signed). �-••�
10 7g [ l
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No.._.�7.1Z& Date... /(/ / �
7 r Z.- Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
uilding Inspector My Commission Expires
to me well known,
PLANNING BOARD DATE
Chairman Member
Member Member
Member ...... — - -- - ._ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
Owner
/
Date 3 - 2' Job Address IC '' TS1 Tax Folio J' ..9020_5" e / B//o 1--'
Legal Description I E ' ., C. L_.,+ _ C s So Z. Ens
B�. S
/ � � j Q it /,r ��. ' "
Tenant A" • ,4oLI a�+J j , e C_' Master Permit #5
Lessee
Owner's Address
Contracting Co. Sl1V1 IMJA)0ct-\\S, �4;
Qualifier 4— :n10,1 L SS# '
State # G aS 4 Municipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING FENCE SIGN
WORK DESCRIPTION 2 : eac1-1,._5 (' ... (Jr ,P71 46 �
Square Ft. ) e #S O Estimated Cost(value) 1, 0UU
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of
Date:
/
owner and /or Con
144 . j 04. 1 d ,
s to Owner an or Condo
Notary of / President
My Commission Expires:
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
l 1NX ZC f 3h T itleg d Phone F5
't
NOTARY PUBLIC STATE OF FLORIDA
MY COMAGSSION EX'.DEC.14,1995
BONDED THRU G.E VERAl. INS. UNi .
** * *
FEES: PERMIT )15(O`Y" RADON
Fire
Zoning Buildi
Mechanical Plumbing
- Phone co-cos W-7,16-Vo3
Signat
Date:
* * *
Address - P•0•7 3 mx 4 3 2 -to '/ r47i[i
Notary as to Contra or or Owner- Builder
My Commiss
Ins
Co . �•
04ia
Owner - Builder
# 4/ ecanchk
AUNA M. SANCHEZ
°` MY COMMISSION o CC 0460:.
�: ��,,r; EXP ?R : Septemb 10.1394 *
,t4 410 Banded lhm Notary FOE Ilidan/fflers
**
C.C.F. Pv 66 NOTARY TOTAL DUE 7 __d
Other
Electrical
Engineering
SKETCH OF SURi/EN.
.e,"a:31- -4
/O79 ia/ 47 94
Mi•NO/ S t'G "La 4',
3 @a8
,if,41 , L 1 LEGAL DESCRIPTION
',that part 42 Tract 1Wf plat of Government Lot 4, of'ction `i, Township 53 South,
ge Eat, as recorded in Plat Book 5, Page 90, of the Public Records of Dade County,
' Florida, bounded as follows:
Starting at the intersection of a line parallel to and 8U feet North of the South line of
Tract "K" and the data of Fast Dixie Highway; ruattrz,viisterly along the West line of
East Dixie Highway a distance of 76 feet; Thence West Parallel to the South line of Tract
"K' a distance of 133 feet to the point of beginning of the Tract h rein described; Then
continue West parallel to the South lime of Tract "K" a distance of 117 feet; Thence: Smut
at right angles to the last mentioned line a distance of 74.28 feet; Thence East at right
angles to the last mentioned line a distance of 117 feet; Thence North at right angles
to the last mentioned line a distance of 74.28 feet co the Point of Beginning.
1078 N.E. 94th Street Miami Shores, Florida 33138
T H E F L A F O O NSU
DATED
UNITED STATES OF ROOM
DELINEATES THE HEREIN
SITUATED WfFHIti ZONE
NOT VALID mums EmaoSSED Sf •
,, A_
RATE MAP,
PUBLISHED BY THE
AND URBAN DEVELOPMENT,
1 LAND TO BE
LOC 11O'N SKETCH
SCALE: 1° =5-)
ci:a -'w �.;- .e . - J
I I
v
ATE OF Ps. IDA
DATE: War ary 15. i988
CONTINENTAL LAND SURVEYORS INC.
1700 8. W. G7 AVENUE, SUITE 201
MIAMI, FLORIDA 33156
TEL. Woo 202 -1935
WE HEREBY CERTIFY: Thal the attached SKETCH OFF SURVEY of Plc dime described correct to Iho of our
moody belief 'NS nth surveyed under ow direction, also CM are rt .. w.. • :` y :r..: ;•� � and ft* sunmly
roasts Wnanum Tedvta9 S1andarda let by the FLORIDA BOARD OF LAND SURVEYORS as set fcrth in Chapter
472.027 (F.S.) and Chapter 21 HH 6 of the Florida Administrat Code
FOR: __.�u1x uA. iiazve�y S„
ORDER t °. 2 - 0 - 14 •
i 4 . / _
PRLF SS . < LAND SURVEYOR No 2052
Page 2
1 MPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT H,R1jING'112CEIVEp VALQ10ED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAWTP•INED Ile 4A C IJEfti'.AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SMALL $ )r ilea ntE 044 114 DOT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEIPQ3 DAMA1Fj1eY C JIEMtNr OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk. • • ••• • • • • • • •
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
, T.ATE
'1 Signature of Oyler
mem
1>< Eici
•nt Name _"
Swo to and subscribed before me this t day of i- -� b(tl,O
Signature of Notary Public - State of Florida
SEAL:
Personally known
• •
•
• •
• •
••• •
IAMI -DADE
Type of Identification Produced: Ft_ . . 1- 4 5 a
• • • •
• •.• • • •
• • • • • •
••••••• •
STA 4h F FLO Y OF MIAMI -DADE
Name
Sworn to and subscribed before me this 1 cg day of
SEAL:
(2'rmot - !U.6"
Signature of Notary Public - State of Florida
Type of Identification Produced:
PERMIT APPLICATION
ts ar America Mattes • • my Commission DD141009
V. r ,,d" Expires August 12, 2006
America ,Matias
4 ISAyCommission DD141009
a ,:df Expires August 12, 2006
OR, Produced Identification Personally known OR, Produced Identification
• O r .
PROPERTY OWNER
Name (.1.K‘_ A ....0
Address
\ % Wt c \S \Sc+O S Q i
Home Telephone
11)05 _ CA 3b��
Business Telephone (7;<■3 + t iog — 4,\ \\a Qom\ N3-)`
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
Step 1.
Job Address: 101
Address
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
• ••• • • • •••
• • • ••• • • •
• • • • • • • • • • •
• • • • • • • • • •
• •••
PERMIT APPLICATION
.•. • tvlaRteq Petit NQ. £ P , Co_gi
. • • S *bsidi iry PeImit No.
••. •.• • • •
I NSTRUCTIONS - The following steps must be taken to obtain a p rmit from the l\'liami Shores Village:
•• • • • •• ••• ••
Complete the attached permit application which must be si WTbrope yy Veer'agd qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of yrreptlioartiln.stfrodfing world will be done, a roofing application must be submit-
ted along with this permit application. • • • • • • • • • • • •
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Apt. City
State
A rrscription of Work �) �w � $2•\.;
Zip
Zoning Linear Feet
Square Feet Units Floors
l)f
alue of Work 010 — Bldg Value
ax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
)
(\c"
TO 39dd
Alan Smith
Resident Miami Shores
on)
Date: December 2
To: Deco Concrete and Asphalt
From: Alan Smith
Re: Sealing and Painting of Concrete Driveway and walkways
This memo is to notify Deco Concrete that notification is being made to the
Miami Village Town Hall and contractor's board regarding poor
workmanship (paint popping off of driveway and walkways) of work
performed last Feb. 2003.
1 have attempted contact with Gus Torres numerous times over the last two
months, and have had retum phone calls twice. He has stated that he would
come two times and has never came as far as I am aware.
I am forwarding this email to Miami Shores Village Hall to prevent other
customers from using this concrete company.1 was told when I signed the
contract for this work that I could call for any problems, and the customer
service has been much less than satisfactory. Many people have stopped and
asked who did the work, and I have given them the business card of this
company. I am very unhappy with the quality of the work and would not
recommend their use in the future.
Cc: Miami Shores Village
/0 /vg s l,
1WJW BS"D
43P 03— .‘qf
8TESS8SSOE
BTzSSBSSB2
OS :BO 1700Z/0E/it
0
c]
co
0
0
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/19 /2003
Applicant: MAR11.41
Owner: — B914-T-®T
JOB ADDRESS: 1078 NE 94
Contractor
Local Phone:
Parcel # 1132050070190
Permit Status: APPROVED Permit Expiration:
"'--- Work: DRIVEWAY SEALING
•
N
memo' <-
DECO CONCRETE, INC.
9804 NW 80TH AVENUE
HIALEAH GARDENS, FL 33016
PH. (305) 828 -5158
8/18/2003
ST
Contractor's Address:
BOUI01
ill,<PePie
11'00575411' 1:0670084 L4l: 11' 9660 L6 LL
Construction Value: $1,000.00
UNION PLANTERS BANK
HIALEAH GARDENS, FL
63-841/670
ermit
Permit Number: BP2003 -269
;.J
Legal Description: 5-6 53 42 .19 AC M/L PL OF GOVT LOT 4
Page 1 of 1
PB 5 -90 PORT OF TR K DESC BEG SE
Fees:
FEE2003 -1045
FEE2003 -1046
Description
Building Permit Application Fee
CCF
Total Fees:
Amount
$60.00
$1.20
$61.20
Total Fees: $61.20
Total Receipts: $0.00
.5754
$
colla4s 8
;pection
lerefor in strict compliance with all
s that may have been submitted to
1e plans are changed without
Iity for a thorough knowledge of the
assumes responsibility for work done
taining thereto and in strict conformity
isibility for all work done by either
MIAMI SIJORES:VILLAGE • Paint'i:�lor �ppr q �� l a nd:Agreement
• ••• • ..•
•
•• • •
• OWNER'S NAME: , 4/� 7 D ' . ••' ••• *ALONE: 3 (5- 75/ x257
ADDRESS: 1O7y NE 1A- 1A- � C J31
**** * * * * * * * * * * * * * * * * * * * * * * * ** ** * * *1 4�ks��c 'c * * * * * * * * * * * * * * * * * * * ** • •
ADDRESS OF SITE: `\.:, \�: . •°� y� ; asp � , 51 � c L 33 ���
CONTRACTOR & LICENSE (ifapplicable)
COMPANY NAME :Go� - �, \ @ ��e�••• ■ .q PHONE: 3()5 - � Ca -3 ��,��
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
DATE: � -/N
sa les. , ,44.9f
Signature of Owner
APPROVED:
Building Offic Date
•
• •
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters
Awnings
�\
g
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
c:9
Date
� TERRA COTTA *t •
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate
and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I authorize the above - named contractor, if • •plicable, to
do the work stated. Furthermore , the paint colors 1 be as the • ttached
EN PAINT F G IS FINISHED,
CALL FOR FINAL INSPECTION
re of Contr • 'r Da e
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *, * * * * * * * * *. * * * * * * * * * * * * * * * **
4/23/01
ELECTRICAL
'I'YI'E
Minimum Fee
QTY.
'1'1'1'1?
Dryer _
QT` :.
• • •
"1'1'1'1-
Outlet, • penance _ • •
(En'.
TYPE
Service Repair
)"rv.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE: QTY.
Condensate Drain
TYPE
Generator
QTY. 'INN.: QT\J.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
TYPI.
Drains, Roof
QTY
. 1 ypE
Miscellaneous Fixture
QTY
Ty pi.:
Soakage Pit
()Ty
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair •
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
•
• • • •
• • • ••• •
• • • • • •
• • • • • • • • •
•
• •
• •
• .••
• • ••• • •••
• • •• • • • •
-1P-41-0
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work beidg perfdrmedand tiu'intitAies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
D E /
Zonin_
`' / £
( 25
Electrical
/
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
02% i I 1 I I
��7
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
•
• •
• •
• •• •
••• •
• ••
• •
• ••• • •
• • • • •
•••••••
••• •
•
• • • ••• •••
❑ PROOF OF OWNERSHIP
(Attach)
•• ••• •• • • • ••
DBRM'f LOYAL
• • (5Cptfc P SedVer)• • • •
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
$
b
$ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
•••
•
•
•
( x .6 x/1000
)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ t
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com