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DEMO-10-623Miami Shores Village Building Department 10050 N.E2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 X BUILDING PERMIT APPLICATION FBC 2004 xll f 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: n Pia „4 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 -*