EL-15-371 (2) Patmit NO,
�sNOk a,� Miami Shores Village Y fVl mt TYt e Electrical sit�tI
10050 N.E.2nd Avenue NE
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Miami Shores, FL 33138-0000
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e Phone: (305)795-2204
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"3/27/2015 ''FlExpiration: 09/23/2015
Project Address Parcel Number Applicant
371 NE 103 Street 1121360130270
Miami Shores, FL 33138- Block: Lot: GONZALO&JOHANNA NOALE:
Owner Information Address Phone_ Cell
GONZALO&JOHANNA NOALES 371 NE 103 Street (305)632-9753 "
MIAMI SHORES FL 33138-
371 NE 103 Street
MIAMI SHORES FL 33138-
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Contractors) Phone Cell Phone Valuation: $ 500.00
LS CURTIS INC 305-892-0115
Total Sq Feet: 0
Type of Work:2 SCONES+2 GFI Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning: 1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# EL-2-15-54546
$2.25 03/27/2015 Check#:2792 $ 159.10 $0.00
DCA Fee $2.25
Education Surcharge $0.20
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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-na ctor to do the work stated.
March 27, 2015
Authorized Signature:Owner / Applican o tractor / Agent Date
Building Department Copy
March 27,2015 1