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Permit No .&/ L1-6) Date
Application is hereby made for the approval of the detailed statement of tbe 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 Buildhlg Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications snust be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and/or En en
Size Septic Tapir
Feat of Drain Tile
il Loca -21 non 4‘ in/Legl ° ption 1,00_ Less C Bior4 Subdiviolooff
Street and Number where work is to be performed—No 1130 0 flJ g Street—c:
State work to be perfonnell and purpose of building (By Floors) g
New Building — Remodeling Addition Repairs_
Type of Tank--_
nist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit_
.7 57_
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
g ?C(P
xr c :P-c7s r—
)9-z,
Street. le
S
No.. of Stories.
—Capacity
(signed) NI tetiSiO3CA0 t3j
Plumbing Inspector. -
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 Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and loav com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wort- to he
performed under this permit; and will post or cause to be posted far 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 this perinit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A rainspectlim fee of ;LOD will be mad. whoa seek miaspaotkm is made. netaissery by improper notice for hopectIon, et faulty
materials and/or workmanship.