EL-15-850 (2) \ gj105'� 't_17111187
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Miami Shores Village y.■ p r
10050 N.E.2nd Avenue NE0, on
Miami Shores,FL 33138-0000 ,
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Phone: (305)795-2204
4 �2t)4 Expiration: 10/20/2015
Project Address Parcel Number Applicant
171 NE 102 Street 1132060131840
Miami Shores, FL 33138- Block: Lot: STEPHEN C MUMBY JTRS
Owner Information Address Phone Cell
STEPHEN C MUMBY JTRS 171 NE 102 Street (646)246-3448
MIAMI SHORES FL 33155-
Contractor(s) Phone Cell Phone Valuation: $ 2,300.00
LONGMAN ELECTRIC INC (305)758-1211
., Total Sq Feet: 0
Type of Work:KITCHEN REMODEL Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
Invoice# EL-4-15-55170
DBPR Fee $3.38
DCA Fee $3.38 04/23/2015 Credit Card $ 189.56 $50.00
Education Surcharge $0.60 04/13/2015 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $225.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $239.56
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 ELECTRIC PLUMBING,MECHANI AL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I ify tha all the f g ing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin uthermore uth rize a above-named contractor to do the work stated.
April 23, 2015
Authorizedig ature:Owner / Applicant Contractor / Agent Date
Building Depart opy
April 23,2015 1