PL-16-789Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit NO. PL-34.6-789
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: APPROVED
is3ue Sate: 3/26/2016
Expiration: 09/21/2016
Applicant
15 NE 104 Street
Miami Shores, FL 33138-2026
1121360120090
Block: Lot:
ABDUL S MUKHTAR CAMILLE H
Owner Information
Address
Phone
Cell
ABDUL S MUKHTAR CAMILLE HARRIS 15 NE 104 Street
MIAMI SHORES FL 33138-2026
15 NE 104 Street
MIAMI SHORES FL 33138-2026
Contractor(s) Phone Cell Phone
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Valuation:
Total Sq Feet:
$ 8,500.00
0
Type of Work: REPLACE SEPTIC TANK & DRAINFIELD
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$4.50
$4.50
$1.80
$5.00
$300.00
$9.00
$7.20
$337.40
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-3-16-59144
03/25/2016 Check #: 5053 $ 337.40 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval,,
Final
Review Plurribitig, jt
</eda
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-rjamed cpntractor to do the work stated.
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Authorized Signature Owner Applicant Contractor / Agent
Building Department Copy
March 25, 2016
Date
March 25, 2016 1