PL-05-19-1117, 1420 NE 101st StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Contacts
Parcel Number
1132050230050
MATTHEW ALLEN Owner VAN KIRK & SONS INC Contractor
1420 NE 101 ST, MIAMI SHORES, FL 33138 ROBERT P VAN KIRK JR
Other: 3056732847 3144 SW 13 DR, DEERFIELD BEACH, FL 33442
Business: 9547554402 esandoval@vankirkpools.com
Other:7863262747
_.--- _...-....-_ _..--_...._-.-...._.__.._....................................._...-_......m.......�........ ........ ..-_....-----.........\ Inspection Requests:
Description: PIPING FOR NEW FOUNTAIN Valuation: $ 21,000.00 41?i�1 EIy E
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$12.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$4.20
Plumbing - Pool - Residential
$100.00
Scanning Fee
$9.00
Technology Fee
$3.75
Total:
$183.55
Payments
Date Paid Amt Paid
Total Fees
$183.55
Check # 43464
06/13/2019 $133.55
Check # 43392
05/16/2019 $50.00
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: Ithat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regul4gin—giQnstruction an zon g. Futhermore, I authorize the above named contractor to do the work stated.
W
r / i Applicant / Contractor / Agent
Date
June 13, 2019 Page 2 of 2