PLUMBING PERMITS MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PWMBING PERMIT
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and an provisions of the Laws of the State of Florida,all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with,whether berein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address_MR 1 J.H. POWELL No. 225.NsVI, NO Street
Registered Architect and/or Engineer MR PAUL HARRISON
Employing Plumber's Name_ 5.RTER PT D fRTIVC', CORE_ _ No..],?..1.,.35.--. s n-ue.--.
Location and Legal Description Lot 7 Block tg6 S
Street and Number where work is to be Va*nned No 120G X Z 103 Ste_
State work to be performed and pwpose of building (By Floors) ------ -- -- --- ---- ------
New Building_.._.X._..____- __-_.Remodeling____ Addition____... _._..-. Aepaira___-_______.__--__-- No. of Stone _z------
ATM
------_._ _.
BATH gNOWERO LAVA- 8iN%8 SLOP LAUNDRY URINALS CATCH FLOOR DRINKING TOTAL
CLOSETS TUBS TORIIIS SINKS Tuns BASIN GRAIN FDUNT'NB FmtTURp
LIST
CHECK
SEPTIC SEWER DRAIN SOAKAGE okASE DEW emr.LR. SWIM'G t
TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL
COWS. 4
LIST
CHECK
Sin septic Tank----_------. Type of TWA ---
Feet of Drain Tile DlsL Feet of Tank or Drain Field from WeIL._.._ --
Natu re of Water Supply: Qty—Well. City l'` Size of Soakage Pit_
Amount of Permit $--�J!� =% (Signed) -
Plumbing laspector.
The undersigned applicant for this building permit does Hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Worlanen's Compensation Act,being Section 59th,Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof,and will><equira similar Compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit;and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-oontractars, on work to be pedbimed now this Permit, w are
licensed by Miami Shores Village. Sign
/
. ( 1l�aster Plumber..._ -
STATE OF FLORIDA, t
COUNTY OF DADE.
Before mor,the undersigned authority,a notary public duly autheuized to administer oaths and take aclmowledgmelsts, personally appeare
to me wou limawn,and who;being by me first duly sworn,upon oath ores and says that he is
of the above d t�ruction, that he has carefully read the foregoing application, and that hedid sign the same, and that all far
therein by him stated are true.
Xe-
NOTE:
mmission empires Notary Public,State of Florida
fee of $1.00 will be made when such re-insp�n is made necessary by improper notice for inspection, or faul
materials anip.