Permit Application — Ralph Guzman, C 200017715 (2005)

MIAMI-DADE COUNTY BUILDING DEPARTMENT Permitting and Inspection Center 11805 SW 26th Street, Suite 200, Miami, FL 33175 Phone: (305) 371-5100 PERMIT APPLICATION 2000077715 2200200707 2200200713 Job Address: 6200 SW 87th Ave City: MIAMI Zip: 33143 Contractor No. (CAL057713) Contractor Name: RICHARD GARCIA Contractor License: CAL057713 Contractor Address: 8700 SW 107th Ave City: MIAMI Zip: 33173 Current use of property: SFD Description of Work: Shingles Sq. Ft. Value of Work Owner's Name: RICHARD GARCIA Owner's Address: 6200 SW 87th Ave City: MIAMI Zip: 33143 Phone Type of Improvements New Construction Addition Alteration Interior Alteration Exterior Relocation of Structure New Roof Recovery (Roof) Repair - Due to Fire Demolition Addition - Detached Addition Attached Re-roof Exposure Permit Type W Building C Electrical M Mechanical P Plumbing E Elevator S Special Report to an Existing Permit RESIDE Name: [illegible] Address: [illegible] City: MIAMI Zip: 33143 Bonding Name Address City State Zip Architect/Engineer Name Address City State Zip Contractor Name Address City State Zip I certify under penalty of law that this document was drawn up under my direction or supervision in accordance with the system of documentation adopted for preparing documents in this matter. I further certify that this document was prepared or approved by me as a holder of a valid license issued by the State of Florida in accordance with the laws of the State of Florida. OWNER'S REPRESENTATIVE MUST SIGN THIS FORM. IF OWNER IS AN ENTITY, THE AUTHORIZED REPRESENTATIVE MUST SIGN. IF OWNER IS A CORPORATION, THE CORPORATE OFFICER MUST SIGN. IF OWNER IS A PARTNERSHIP, THE PARTNER MUST SIGN. IF OWNER IS A TRUST, THE TRUSTEE MUST SIGN. IF OWNER IS AN ESTATE, THE EXECUTOR OR ADMINISTRATOR MUST SIGN. IF OWNER IS A LIMITED LIABILITY COMPANY, THE MANAGING MEMBER OR AUTHORIZED REPRESENTATIVE MUST SIGN. Signature of Owner / Owner's Agent Date: 1-1-05 Printed Name: LINDA GARCIA Title: Owner's Agent Phone 31