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EL-11-2231
/4, 9.9/5-7.1-6 Miami Shares Village Building Department 10050 N.E.2nd Avenue, Miami Shores,'Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Q °' OWNER: Name (Fee Simple Titleholder): Phone #K3/ 6 2 (L SI (/ 7 Permit No. 11-zol Master Permit No. Address: r :!.�..._ % !._ City: ��,'� ' *... State: / Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: F City: Miami Shores County: Dade Zip: 33i31" • Folio/Parcel #: / /"` 4 —v /% /WO Is the Building Historically Designated: Yes CONTRACTOR: me: A Company N 7. "/ Address: City: NO ' �,AY Flood Zone: Qualifier Name: State Certif ation or Registrion #: Contact Phone #: Email Address:_: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 1 Square/Linear Footage of Work: Type of Work: UAddress, 141teration New URepair/Replace UDemolition Zip: a 3-e�l Phone #: of Competency #: Description of Work: Submittal Fee $ Permit Fee $ ,. /e • 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $