PL-15-2667 3Y
Miami Shores Village Pf#fM3 s;lentil
10050 N.E.2nd Avenue NE 3
Ck�S� i f'ai![I Itl
fN Miami Shores,FL 33138-0000
L
h ` Phone: (305)795-2204 F01iE[}
:,, .
2j20-it Expiration: 0411912016
Project Address Parcel Number Applicant
161 NE 107 Street 1121360070300
Miami Shores, FL Block: Lot: PABLO F SOUTO
Owner Information Address Phone cell
PABLO F SOUTO
FL
Contractor(s) Phone Cell Phone Valuation: $ 3,550.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 300
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Return:
Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# PL-10-15-57485
DBPR Fee $2.25 10/22/2015 Check#:1004 $ 119.90 $50.00
DCA Fee $2.25
Education Surcharge $0.80 10/20/2015 Check#:1003 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $169.90
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 zoni uthermore,I authonVe the ove-named contractor to do the work stated.
(.A October 22, 2015
Authorizedignat re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 22,2015 1