PL-15-2506 �t
Miami Shores Village
10050 N.E.2nd Avenue NW €
Miami Shores,FL 33138-0000
Phone: (305)795-2204 .<
Expiration: 04103/2016
Project Address Parcel Number Applicant
118 NW 111 Street 1121360030420
Miami Shores, FL Block: Lot: KNUT OHLSSON
Owner Information Address Phone Cell
KNUT OHLSSON 118 NW 111 ST
MIAMI SHORES FL 33168-4323
Contractor(s) Phone Cell Phone
Valuation: $ 3,200.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
......_.__.....�_,�..., _ _..._ Total Sq Feet: 0
Type of Work:DRAIN FIELD INSTALLI Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Return:
Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-10-15-57279
CCF $2.40 10/06/2015 Credit Card $ 119.90 $550.00
DBPR Fee $2.25
DCA Fee $2.25 10/01/2015 Credit Card $50.00 $500.00
Education Surcharge $0.80 10/05/2015 Check#:662 $500.00 $0.00
Permit Fee $150.00 Bond#:2862
Scanning Fee $9.00
Technology Fee $3.20
Total: $669.90
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 taws regulating
construction and zoning. Futhermore,1000ze thealamiernamed contractor to do the work stated.
October 06,2015
Authoriz gnature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 06,2015 1