PL-15-1821 (2) Permit N�?. L' '
Miami Shores Village P�lfl` Ype pIUtY1�?t1I �d1
g3 10050 N.E.2nd Avenue NW ` ar � �t�(ilx3SlJtCtif7 � Prate
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Miami Shores,FL 33138-0000
��— Phone: (305)795-2204
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� A' Expiration: 02/2712016
Project Address Parcel Number Applicant
_........r_
5 NW 107 Street 1121360070480
MILLICENT MCFADDEN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MILLICENT MCFADDEN 5 NW 107 Street
MIAMI SHORES FL 33168-
5 NW 107 Street
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone f $ 2,000.00
ROSMEL POOL INC (305)592-7900 i Valuation:
Total Sq Feet: 00
Type of Work:NEW POOL PIPING Available Inspections:
Type of Piping:
Inspection Type:.
Additional Info:
Main Drain
Bond Return: Final
Classification:Residential Scanning:3 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-7-15-56411
DBPR Fee $3.38 07/21/2015 Check#: 12898 $50.00 $ 193.96
DCA Fee $3.38
Education Surcharge $0.40 08/31/2015 Check#: 12993 $ 193.96 $0.00
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $243.96
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 infor tion is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above med contract to do the or stated.
Z August 31, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
'%ugust 31,2015 1