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ELC-12-1036Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30S) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Trbadw A't.l- Permit No. ( L-r—,.I e;t— l oJ6 Master Permit No. G Co 1 c-;� ^ 9 30 Permit Type: Electrical _ c 1 9p OWNER: Name (Fee Simple Titleholder): SX are5 �� 1 VdaTT Phone #: (3` S) l qq- 800 Address: q0-34: 6(SC1 r4e VIV City: M s &W S%Arc _ State: rl Zip: 331 3 E Tenant/Lessee Name: CU n uKrao a M • b Phone #:00s) Q3 S. 6321 z Email: _I aiyy--/ S 41a /"i �- JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3-313 R! Folio/Parcelk Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: M5 EG C Cd 009 honek 7 3940 Address: .11 (1 h ann" nn -k City: I y I Qualifier Name: Zip: 33© G 3 t ,' 5+) 5-20 State Certification( or Regi tration #: twC.� 10-1-1 Certificcate/of Competency #: Contact Phone #: C� 3 V O9 Email Address: J �i��d (� 61145 C-- C... • /41 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ®0C' °'' Square/Linear Footage of Work: Type of Work: ❑Address �^❑�Altteeration > .� ONew ORepair/Replace ODemolition Description of Work: �1't...A' '� , C c..a —7kG.,S7 3°;� Submittal Fee Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $