PW-18-464Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pe
Parcel Number
Issue oaf.: 8%2018
Permit NO. PW-2-1 8-464
Permit Type: Public Works
Work Classification: Public Works
Permit=Status: APPROVED
Expiration: 05/27/2018
Applicant
1499 NE 104 Street
Miami Shores, FL
1122320320110
Block: Lot:
PATRICK LONGMAN
Owner Information
Address
Phone
Cell
PATRICK LONGMAN
1499 NE 104 ST
MIAMI FL 33138-2663
(305)677-3046
Contractor(s)
CHAMPION CONCRETE
Phone Cell Phone
(305)252-8055 (786)402-4802
Valuation:
Total Sq Feet:
$ 100.00
0
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o.00
$0.00
$0.00
$0.20
$100.00
$3.00
$0.80
$104.00
Pay Date Pay Type
Invoice # PW-2-18-66541
02/22/2018 Check #: 2796 $ 50.00 $ 54.00
02/26/2018 Check #: 5550 $ 54.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Excavation
Review Public Works
Final Public Works
(Fr
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 con / rmity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume r ponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICA , PLU =ING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT. 1 certi at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zon'r�,Futh: 're, I authorize the above -named contractor to do the work stated.
February 26, 2018
ity• ' - • gnature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 26, 2018 1
Rid 165