10754MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No _4..6_42_ ' ?r
III Date � - •-‘ ./___.
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 all provisions of the Laws of the State of Florida, all ordinances of Miami Shores. Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work
P
Owner's Name and Address -'°'i No Street
Registered Architect and/or Engineer �
Employing Plumber's Name �,/ • 1. - +...A.■ No Street,
Location and Legal Descri • Lot Block Subdivision
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors) 7 d 7 ,/1 S u '� J
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE,
New Building Remodeling Addition
§ize Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
(Signed)
The undersigned applicant for this, building permit does hereby certify that s , -'i • derstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Sectipn 5888, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require aimilsr compliance from all contractors or sub - contractors employed by hind in the work to be
pezfuimed 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 - contractors, on work to be performed under t • s permit, as are
licensed by Miami Shores Village.
rl
(Signed)
Repairs No. of Stories
Plumbing
aster Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
li
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
My Commission Expires
NOTE: A materials and/or re-inspection ec fee of $], LOO will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
�
CLOSETS
• BATH
TO
SHOWERS
II LAVA - --
. '� , .TORIES
SINKS
SLOP
- SINKS
LAUNDRY
TUBS
URINALS
- CATGH
_ BASIN
FLOOR
- DR AIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
• CHECK
SEPTIC
TANK -
SEWER
CONN.
DRAIN
FIELD
- SOAKAGE
PIT
GREASE --
TRAP -
SOLAR .
HEATER
DEEP
WELL
- SPRKLR.
SYSTEM
- SW IM'G
- POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No _4..6_42_ ' ?r
III Date � - •-‘ ./___.
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 all provisions of the Laws of the State of Florida, all ordinances of Miami Shores. Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work
P
Owner's Name and Address -'°'i No Street
Registered Architect and/or Engineer �
Employing Plumber's Name �,/ • 1. - +...A.■ No Street,
Location and Legal Descri • Lot Block Subdivision
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors) 7 d 7 ,/1 S u '� J
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE,
New Building Remodeling Addition
§ize Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
(Signed)
The undersigned applicant for this, building permit does hereby certify that s , -'i • derstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Sectipn 5888, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require aimilsr compliance from all contractors or sub - contractors employed by hind in the work to be
pezfuimed 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 - contractors, on work to be performed under t • s permit, as are
licensed by Miami Shores Village.
rl
(Signed)
Repairs No. of Stories
Plumbing
aster Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
li
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
My Commission Expires
NOTE: A materials and/or re-inspection ec fee of $], LOO will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
�