WS-15-2932 zu-v
Miami Shores Village 10050 N.E.2nd Avenue NEMiami Shores,FL 33138-0000ratiPhone: (305)795-2204 y ' � a,, �< €,.'� ,,
` on: 011 2016
Project Address Parcel Number Applicant
1130 NE 91 Terrace 1132050010410
Miami Shores, FL Block: Lot: BARBARA TER HORST
Owner Information Address Phone Cell
BARBARA TER HORST 1130 NE 91 Terrace (305)432-1775
MIAMI SHORES FL 33138-
1130 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 29,641.00
AMERICAN STORM PROTECTION (305)264-0446 (305)513-0514
Total Sq Feet: 420
Type of Work:REPLACING 18 IMPACT WINDOWS AND 31 Available Inspections:
No of Openings:21 Inspection Type:
Additional Info:
Classification:Residential Window Door AttachmentFinal
Scanning:3 Review Building
Review Building
Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $18.00
DBPR Fee Invoice# WS-17-15.57828
$4.65 11/19/2015 Credit Card $50.00 $326.30
DCA Fee $4.65
Education Surcharge $8.00 12/17/2015 Credit Card $326.30 $0.00
Permit Fee $310.00
Scanning Fee $9.00
Technology Fee $24.00
Total: $376.30
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 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 zoning. Futhermore,I authorize the above-named cont motor to do the work stated.
`SJ December 17,2015
Authorized Signature:Owner / Applicant / Gbritractor / Agent a e
Building Department Copy
December 17,2015 1