DEMO-15-2950 (2) 6 � 3
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 � �
Phone: (305)795-2204
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Expira
tion: 05/22t2®16
Project Address Parcel Number Applicant
1155 NE 100 Street 1132050190331 SIMON JAMES GOBLIN
Miami Shores, FL Block: Lot:
Owner Information Address Phone cell
SIMON JAMES GOSLIN 1155 NE 100 Street (305)766-9635
MIAMI SHORES FL 33138-
1155 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $400.00
METRO ELECTRIC SERVICE,INC (305)945-1991 (305)945-1991
---� Total Sq Feet: 0
Type of Demo:Electric Available Inspections:
Additional Info:ELECTRICAL DEMO
Inspection Type:
Classification:Residential
Final
Scanning:3
Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# DEMO-11-15.57855
DBPR Fee $2.00 11/24/2015 Credit Card $64.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 11/23/2015 Check#:13595 $50.00 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 t of formation is accurate and that all work will be done in compliance with all applicable laws regulating
construction aadeantn. Fyfh +gie above-named contractor to do the work stated.
November 24,2015
Auffio r / pplicant / Contractor / Agent Date
Building Depa a opy
November 24,2015 1