EL-17-1729 (4)Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
LORiDA
Permit No. EL-7-17-179
-02 ON Permit Type: Electrical - Residential
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Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 7/20/2017 1 Expiration: 0111612018
Project Address Parcel Number Applicant
500 NE 103 Street 1132060170930
ANGELA CARBONA
Miami Shores, FL 33138-2458 Block: Lot:
Owner Information Address Phone Cell
ANGELA CARBONA 500 NE 103 Street (516)849-1536
MIAMI SHORES FL 33138-
500 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
EMPIRE ELECTRIC MAINTENANCE & 305-264-9982
of Work: ELECTRICAL FOR KITCHEN REMODELING
onal Info: ELECTRICAL FOR KITCHEN REMODELING
ification: Residential
(Scanning: 1
Fees Due
Amount
CCF
$2.40
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.80
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$3.20
Total:
$163.90
Valuation: $ 3,400.00�
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-7-17-64485
07/20/2017 Check #: 1275 $ 113.90 $ 50.00
07/05/2017 Check #: 1239 $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
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
construction and zoning. Futhermore, I authorize the a
Authorized Signature: Owner / Applicant
Building Department Copy
rate and that all work will be done in compliance with all applicable laws regulating
'tor to do the work stated.
Agent
July 20, 2017
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