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10050 N.E.2nd Avenue NW ■#
Miami Shores,FL 33138-0000
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a e— , Phone: (305)795-2204
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�f1201 _ Expiration: 02127l2016
Project Address Parcel Number Applicant
5 NW 107 Street � 1-121360070480 �
MILLICENT MCFADDEN
Miami Shores, FL 33138- Block: Lot:
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Owner Information Address Phone Cell
MILLICENT MCFADDEN 5 NW 107 Street
MIAMI SHORES FL 33168-
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5 NW 107 Street
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone $ 2,000.00
YORK ELECTRICAL CONTRACTOR C, (305)962-0759 1 Valuation:
Total Sq Feet: 00
r
Type of Work:ELECTRICAL ROUGH FOR NEW POOL Available Inspections:
Additional Info:
Inspection Type:
Classification:Residential Final
Scanning:3 Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-7-15-56412
DBPR Fee $4.50
DCA Fee $4.50 07/21/2015 Check#: 12898 $50.00 $271.20
Education Surcharge $0.40 08/31/2015 Check#: 12993 $271.20 $0.00
Permit Fee-Additions/Alterations $300.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $321.20
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 iT�iE
nd that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the abdo the work stated. <
August 31, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
Nugust 31, 2015 1