PL-16-1102 v
oof1k Na F, i
a y
Village ROsa it
Miami Shores
10050 N.E.2nd Avenue NE [ j8y,p`,� i�on
.... .. �*
Miami Shores,FL 33138-0000 L �
03
Phone: (305)795-2204 �
Expiration: 11/21/2016
Project Address Parcel Number Applicant
9942 NE 4 Avenue Road 1132060171220
Miami Shores, FL Block: Lot: WARREN WILSON
Owner Information Address Phone Cell
WARREN WILSON 9942 NE 4 AVE RD
MIAMI SHORES FL 33138-2480
Contractor(s) Phone Cell Phone
Valuation: $ 1,300.00
CASTELLON PLUMBING CORP 305-553-1490
Total Sq Feet: 0
Type of Work:Plumbing to convert 1 1/2 bath into Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Top Out
Bond Retum:
Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# PL-4-16-59519
$3.38 05/25/2016 Check#:4069 $242.96 $0.00
DCA Fee $3.38
Education Surcharge $0.40
Notary Fee $5.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $242.96
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a zoning. Futhermore,I aA fi
uto ize the above-named contractor to do the work stated.
May 25, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 25,2016 1