EL-05-144 £ py"
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Miami Shores Village "errriFfyj3e Eittiili4 )+fetit)a)
g� 10050 N.E.2nd Avenue NE
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Miami Shores,FL 33138-0000
P1 . ts AFS.IES
�ZoRw Phone: (305)795-2204
W 619/2005 Expiration: 06/30/2006
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Project Address Parcel Number Applicant
1301 NE 100 Street 1132050140020
PETER MARGOLIS
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
PETER MARGOLIS P.O. BOX 530188 (305)859-2112
MIAMI FL 33153-
Contractor(s) Phone Cell Phone Valuation: $ 300.00
MARDECK ELECTRIC INC 954/888-1765
.. _ ..... .._ ....._.... ......... _.. . Total Sq Feet: 0
Type of Work: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Education Surcharge $0.20 Invoice# EL-1-06-23636
Expired Permit Renewal Fee $100.00 01/15/2016 Check#:918 $211.30 $0.00
Notary Fee $5.00
Permit Fer~-Additions/Alterations $100.00
Permit Technology Fee $2.50
Scanninoee $3.00
Total: $211.30
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 At.vis 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.
OWNERSAFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru '6n'and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
January 15,2016
Authorized natur :O er / Applicant / Contractor / Agent Date
Building artment Copy
January 15,2016 1