EL-16-1580 e Miami Shores Village fT Type,;Elr � ��
10050 N.E.2nd Avenue NE &
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'• ° Miami Shores,FL 3313&0000Pe
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Phone: (305)795-2204 �` A'�
Expiration: 01/09/2017
Project Address Parcel Number Applicant
1350 NE 101 Street 1132050230020
DIRK 8<ELIZABETH PETERSON
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
DIRK&ELIZABETH PETERSON 1350 NE 101 ST
-M[AMI SHORES FL 33138-2611
Contractor(s) Phone Cell Phone $ 1,500.00
Valuation:
LONGMAN ELECTRIC INC (305)758-1211 Total Sq Feet: 0
Type of Work:POWER FOR BOAT LIFT Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-6-16-60095
DBPR Fee $2.25 06/07/2016 Credit Card $50.00 $110.70
DCA Fee $2.25
Education Surcharge $0.40 07/13/2016 Credit Card $ 110.70 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is acts and that all work will be done in compliance with all applicable laws regulating
construction and zoning. thermore,I authorize the above-narrled-eofitractor to do the work stated.
July 13,2016
Authorized Signature:Divner / goicant / Contractor / Agent Date
Building Department Copy
July 13,2016 1