PL-15-898 4V PLA4
sKOs c,� Miami Shores Village EII41
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10050 N.E.2nd Avenue NEja� �t@Il+ tt►FI
Miami Shores,FL 33138-0000 a
Phone: (305)795-2204
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� 3 Expiration: 10/20/2015
Project Address Parcel Number Applicant
171 N E 102 Street 1132060131840
STEPHEN C MUMBY JTRS
Miami Shores, FL 33138- Block: Lot:
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: $ 700.00
LASSETER PLUMBING CO INC (305)525-5075 (305)893-7180
Total Sq Feet: 0
Type of Work:REPLACE FIXTURES ON EXISTING ROUGH Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification: Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-4-15-55222
DBPR Fee $2.25
DCA Fee $2.25 04/23/2015 Credit Card $ 109.10 $50.00
Education Surcharge $0.20 04/16/2015 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
In consideration of the iss nce to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in sq,
i conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I a e responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, LUMBING, MECHNICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I �e�rtify t at I th fo egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning utherm I a hori a the above named contractor to do the work stated.
April 23, 2015
Authorized S g tures Own�/ Ap / Contractor / Agent Date
Building Departmy
April 23, 2015 1