10-1131-002CITY OF SOUTH MIAMI BUILDINC & ROOFING PERMIT APPLICATION
6130 SUNSET DRIVE, SOUTH MIAMI, FLORIDA 33143 (305) 663 -6355
PROJECT ADDRESS: V QF,
9.. t.
PROPERTY OWNER: w'? �.- ...�_... y :1.. i f� °'t I,- E . PHONE
ADDRESS: t� t ( _?� C' ,U�.. S z. . �i ti s s
a �a try E t /
WORK TO BE PERFORMED BY: CONTRACTOR .i.-,/ OWNER/BUILDER
CONTRACTOR
ADDRESS:
PHONE
THIS APPLICATION IS FOR THE CONSTRUCTION OR INSTALLATION Oh: (PLEASE BE SPECIFIC)
V. N ,1NT-
/c -e_;-'
z
USE: RESIDENTIAL M 1, 9 (," 2 _;. F,
SQUARE FOOTAGE j ) 0� `-' S ` F ESTIMATED VALUE,
I UNDERSTAND THAT SEPARATE PERMITS MUST BE OBTAINED FOR ELECTRICAL, MECHANICAL, PLUMBING, ROOFING,
SHATTERS, WINDOWS, EXTERIOR DOORS, PAVING & DRAINAGE AND SIGNAGE. BY SIGNING THIS APPLICATION I ASSOME
RESPONSIBILITY FOR THE CONIPLETION OF THIS PROJECT IN ACCORDANCE WITH APPRPVED CONSTRUCTION DOCUMENTS
AND COMPLIANCE WITH ALL, APPLICABLE REGULATIONS.
SIGNATURE OF CONTRACTOR/QUALIFIER SIGNATU
r
NO'T'ARY: NOTARY/'
o` My Commission D0999692
tlpo v' Expires 08/1212014
ZONING DISTRICT FLOOD ZONE MASTER PERMIT NO.
APPROVED
DATE
DISAPPR.
DATE -
COMMENTS
FEES
ZONING
-
71
_
CITY
so
CODE ENT
COUNTY
ST'RUCT.
RADON
ROOFING
BLDG.
FINE
PLUMB.
REVIEW
ELECT.
NIECH.
1
4
TOTAL
CONDITIONS.
APPLICATION RECEIVED BY: _ PERMIT NO. {) �3