3333Permit No.. _.
Size Septic Tank_
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $
MIAMI SHORES VIL? AGE
PLUMBING INSPECTION DEPARTMEiv
APPLICATION FOR PLUMBING f': +�`
MMc (79
Application is hereby made for the approval of the detailed statement of the plans and speciii ations 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 net A copy of approved plans and specifications must be kept at
building during progress of work,
Owner's Name and Address
Registered Architect and /or Engineer yy
Employing Plumber's Name Mimi, PieaEER �'p7l( //ii/K No.
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By Floors)
k T ' -- ai No . _. � / 3 .. street.
/ 76
Blorlc
Date
Street V i ki 6
Subdivision
1P30 0 Street---__&_' ' 2, A ve
New Building Remodeling Addition Repairs ..__._
Type of Toole
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit_
(Signed)
No. of Stories_
_Capacity Gds.-.__ - _ _
.......
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require 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 public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, , k to ed under this permit, as are
lieu by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undyed authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
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 hhn stated are true.
My Commission Expires Notary Public, State of Florida
ve
NOTE: A re-inspecidon fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSET.
BATH
TUBS
SHOWER .
L
TORIES
SINKS
SLOP
SINK.
LAUNDRY
Tees
URINAL.
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE.
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
Permit No.. _.
Size Septic Tank_
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $
MIAMI SHORES VIL? AGE
PLUMBING INSPECTION DEPARTMEiv
APPLICATION FOR PLUMBING f': +�`
MMc (79
Application is hereby made for the approval of the detailed statement of the plans and speciii ations 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 net A copy of approved plans and specifications must be kept at
building during progress of work,
Owner's Name and Address
Registered Architect and /or Engineer yy
Employing Plumber's Name Mimi, PieaEER �'p7l( //ii/K No.
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By Floors)
k T ' -- ai No . _. � / 3 .. street.
/ 76
Blorlc
Date
Street V i ki 6
Subdivision
1P30 0 Street---__&_' ' 2, A ve
New Building Remodeling Addition Repairs ..__._
Type of Toole
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit_
(Signed)
No. of Stories_
_Capacity Gds.-.__ - _ _
.......
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require 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 public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, , k to ed under this permit, as are
lieu by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undyed authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
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 hhn stated are true.
My Commission Expires Notary Public, State of Florida
ve
NOTE: A re-inspecidon fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.