DEMO-10-623Miami Shores Village
Building Department
10050 N.E2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972
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BUILDING
PERMIT APPLICATION
FBC 2004
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EGNIVIS
APR 1 3 .11
Permit No.IDE ICk0(93
Master Permit No.
Permit Type (circle): < Buildiir Roofing
Owner's Name (Fee Simple Titleholder) ID e v i .6o4 , le Phone # /' 8G 4/2 - 37 So
Owner's Address 9,1 q Cor ft 3t 4A.' o
Citye� Statetf
Tenant/Lessee Name
Zip 334, 3y
Phone #
Job Address (where the work is being done) a /6 ,/t/I /0 S ?.
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # /1- 37- &1,-pyg -6NO
zip ,.3 3 , ?
Contractor's Company Name .sevkiars c rat-) Phone # i 3-S y6-7 Y S'O
Contractor's Address / y 3 °
City l.sC�� -3N
-Qualifier Name
State Certificate or Re 'on No. C /S 1 3 i z-/
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ ] OD n cam'
Type of Work: ['Addition ['Alteration ❑New /Replace 2 Demolition
Describe Work:
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Submittal Fee $ Permit Fee $ CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -*