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EL-16-1793Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. EL -6-16-1793 Permit Type: Electrical - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 11/14/2016 Expiration: 05/13/2017 Parcel Number Applicant 456 NE 100 Street Miami Shores, FL 33138- 1132060170350 Block: Lot: SANTA CRUZ -RESURRECTION I Owner Information Address Phone Cell SANTA CRUZ -RESURRECTION 456 NE 100 Street MIAMI SHORES FL 33138- (786)315-1499 Contractor(s) CJ ELECTRICAL SERVICES INC Phone (954)292-5711 CeII Phone Type of Work: NEW POOL ELECTRICAL Additional Info: Classification: Commercial Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $0.40 Permit Fee - Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 Pay Date Pay Type Invoice # EL -6-16-60361 11/14/2016 Check #: 3334 06/28/2016 Credit Card Amt Paid Amt Due $ 265.20 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named contractor to do the work stated. November 14, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy November 14, 2016 1