PW-19-257Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
17)c n
U tS
Peru No.: PW -02-19-257
Permit Type: Public Works
Work Classification: Public Works
Permit Status: Approved
Expiration: 08/05/2019
10007 NE 4 AVE, Miami Shores, FL 1132060170490 i
Contacts
JOHN & CRISTINA BUTLER Owner JOHN & CRISTINA BUTLER Applicant
500 NE 102 ST, MIAMI SHORES, FL 33138 500 NE 102 ST, MIAMI SHORES, FL 33138
IMBURGIA CONSTRUCTION SERVICES, Contractor
INC.
LOUIS IMBURGIA
Business: 3055255707
Description: CONCRETE DRIVEWAY Valuation: $ 900.00
Inspection Requests:
305,462-449
Total Sq Feet: 1,192.00
Fees Amount
Education Surcharge 0.20
Public Works Permit Fee 100.00
Scanning Fee 3.00
Technology Fee 2.50
Total: 105.70
Payments Date Paid Amt Paid
Total Fees 105.70
Credit Card 02/22/2019 $105.70
Amount Due: 0.00
Building Department Copy
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
regulatin constructio and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized ignature: Owner / Applicant / Cor1 ctor / Agent Date
February 22, 2019 Page 2 of 2