1042 NE 91 Terr (4)Permit No..
$1.11
E;211,
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 Mie:r.i Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatim: of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and speclications must be kept at
building during progress of work.
Owner's Name and Address - S e2 r t NotQ t W • / 3 LS' I Street.
.:(egistzred Architect and/or Engineer
3,mploying Riewaims4-14aami )1
Blorir
Street and Number where work is to be performed—No /05 - Street 9./
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories .
Location and Legal Description Lot
Size S DS.1-. of Tank____ f' C. . Capacity Gals. 9 0 °
Feet of Drain Feet of Tank or Drain Field from Well.
Nature of Water Supply: of Soakage Pit
(signedft qa v) --
Plumbing Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Cupllement, and has con-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed 1 y him in :ce wcrk o b.?
performed under this permit; and will post or cause to be posted for inspection on the site of the work such publi: notice 11 no ice' ,as
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be • rformed •.: this at,
licensed by Miami Shores Village.
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
°
(Signed)
Date.. T/ 9
My Commission Expires Notary Public, State of Florida
.. • .... •
Masts Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, penatrrai ppearec;
to me well known, and who, being by me first duly awom, 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 'arts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection s mede.neoessary by improper notice for inspection, or faulty
materials and/or worlanaruhip.
CLosrns
BATH
TUBS
SHOWERS
LAVA-
TORICII
SINKS
SLOP
SINKS
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'Ne
TOTAL
FIXTI. RES
CONTR.
LICT
CHECK
-
.—...
SEPTIC
TANK
SEWER
CONN.
DRAIN
FICLO
SOAKAGIL
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM**
POOL
...•
CONTR.
LIST
CHECK
Permit No..
$1.11
E;211,
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 Mie:r.i Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatim: of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and speclications must be kept at
building during progress of work.
Owner's Name and Address - S e2 r t NotQ t W • / 3 LS' I Street.
.:(egistzred Architect and/or Engineer
3,mploying Riewaims4-14aami )1
Blorir
Street and Number where work is to be performed—No /05 - Street 9./
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories .
Location and Legal Description Lot
Size S DS.1-. of Tank____ f' C. . Capacity Gals. 9 0 °
Feet of Drain Feet of Tank or Drain Field from Well.
Nature of Water Supply: of Soakage Pit
(signedft qa v) --
Plumbing Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Cupllement, and has con-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed 1 y him in :ce wcrk o b.?
performed under this permit; and will post or cause to be posted for inspection on the site of the work such publi: notice 11 no ice' ,as
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be • rformed •.: this at,
licensed by Miami Shores Village.
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
°
(Signed)
Date.. T/ 9
My Commission Expires Notary Public, State of Florida
.. • .... •
Masts Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, penatrrai ppearec;
to me well known, and who, being by me first duly awom, 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 'arts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection s mede.neoessary by improper notice for inspection, or faulty
materials and/or worlanaruhip.