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PL-18-98 Plermit:=No. pL-1-18-98 �swO1 s y� Miami Shores Village ■; Permit-Type.-Plumbing-Residential s't 10050 N:E.2nd Avenue NE r Work G(assr'ficati©n:Gas Miami Shores,FL 33138-0000 Per, Lam. Permit 5t&tcrs: IPPROVEt9 Phone: (305)795-2204 FtoR,oA Expiration: 09/01/2018 t Issue cam:316/201'8 Project Address Parcel Number Applicant 1266 NE 101 Street 1132050080010 Miami Shores, FL 33138- Block: Lot: NANCY BENNETT TRS Owner Information Address Phone Cell NANCY BENNETT TRS 1266 NE 101 Street (305)710-4819 MIAMI SHORES FL 33138-2414 1 Contractors) Phone Cell Phone Valuation: $ 1,200.00 FOREVER GAS CORP (305)298-0193 Total Scl Feet: 30 Type of Work:RUN GAS LINE 30 FEET FOR NEW GENERA Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning: 1 Review Plumbing r l Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-1-18-66117 DBPR Fee $2.25 01/12/2018 Credit Card $50.00 $110.45 DCA Fee $2.00 Education Surcharge $0.40 03/05/2018 Check#: 1711 $ 110.45 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 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. March 05, 2018 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 05,2018 1 t t k �� l��r�S . � i f ,; � } r i 1