5780 SW 68 ST_EB-96-00 CITY OF SOUTH MIAMI
BUILDING AND ZONING
® ENVIRONMENTAL REVIEW AND PRESERVATION BOARD APPLICATION
STREET ADDRESS OF JOB: 7 6 `� e SOUTH MIAMI.FL
PROPERTY OWNER: a \ `
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ADDRESS: �=e C te l A 1 E -33l��
STREET CITAI STATE ZIP
WHAT IS THE PRESENT USE OF THE PROPERTY?
SINGLE-FAMILY RESIDENCE BUSINESS OFFICE RETAIL STORE OTHER:
APARTMENT OR TOWNHOUSE MEDICAL OFFICE AUTO REPAIR
PLEASE,BRIEFLY SUMMARIZE THE WORK TO BE PERFORMED:
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WHAT WILL THE TOTAL COST BE TO COMPLETE THIS PROJECT? $
APPLICANT'S NAME: TEL NO. 661
ADDRESS: ! l - tSC/ c�`I �- �✓r (X-6,�i P a �l Ot` -
STREET CITY STATE ZIP
AS THE APPLICANT,PLEASE.INDICATE YOUR RELATIONSHIP TO THIS PROJECT
OWNEROF THE PROPERTY TENANT/LESSEE CONTRACTOR OTHER:
OWNER OF THE BUSINESS ARCHITECT ENGINEER
PLEASE. INDICATE CONTACT PERSON(ERPB's decision will be mailed to the contact person indicated below):
PROPERTY OWNER
APPLICANT
OTHER(provide name and address) +
PLEASE SIGN YO 91 NAM N TH LINE ABOVE DATE
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Maintenance Report
Date: Per Car:
7. Date T `6 Ca(f INKNy 69 9-EKglh4,ReDalr-Cost Other Amount Total
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Total
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