1050 NE 91 Terr (15)BUILDING
ELECTRICAL
PLUMBING
ROOFING
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
EJ
❑ DATE
PERMIT N? 7359 Contractor's
License No.
❑ Work to be performed under this Permit
Owner of
Building
Archi tect
Contractor
or Builder
Legal Lot �
Description 1 Bl.
Address of
Building
Subdi-
vision
Value of II Amount of
Project $ Permit $
195
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device des :ribed in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may bo revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition u . son which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed BY:
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation:;
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Mini Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTEORITY
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 11- IS Job Address 1D50 iE 1► Te r r. Tax Folio
Legal Description " l � 01r l 9 11 K a Historically Designated: Yes No
6Vbdld , P a.* P, 4 Iztb . MI
Owner/Lessee / Tenant (� (°. e 2 2-0S Master Permit # 1 /3 7 ,3
Phone 365 3 bl ° 9 ? ,i
Address � n;m3g -hi ` r/b
-
Owner's Address / 0 5 - 0 AV,
Contractin co. Recker-
Qualifier x ///70,6 ? Z -eRr
Permit Type (circle one): BUILDING ELECTRICA
Square Ft. �Od
lr.Ai r
N. ary as to Own =' sf ` ' ' °` d'sident; Date
y Corri sipw , � ; > La fir CwC:
:ZN ��.y
r
FEES: PERMIT
APPROVED:
Zoning Building
Mechanical Plumbing
F'
- Phone
Tre/','
State # 54- OC 0 7/ G Municipal # ti; cO `
Competency # �s. Co. f/�� /. � /.a/,
Architect/Engineer /'i — Address �✓1�✓
Bonding Company ,A✓l - Address X/1
Mortgagor Address /
UMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ' /4-&-/' i� ..c /#i laJ 1 C - :2 /
d6
Estimated Cost (value)
WARNING ¶'O OWNER: Y(I' MUS'II' REC RD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
hIi4.44I/il/ /
w i/Gdt[i��i�sOf rm f s
Si owner -and/or Co do President Date
6 2 --P/3 m /77 -0
ignature of Contract Owner- Builder Date
cseAid 0 ct-e.
Notary as to Contractor or Owner - Builder
My Commission Expires:
MY COMMISSION !J CC492424 EXPIRES
�; August 29, 1999
Pf,t1 souDED 'mu TROY FAIN INSURANCE, INC.
Barkra L. I'ktotca
Phf/f 7
Date
RADON C.C.F. / p NOTARY "� BOND _:?
Electrical
TOTAL DUES
Engineering
Permit No.
Employing Plumber's Name
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.
Owner's Name and Address e _�� --------------- _ - __ -- No._
Registered Architect and /or Engine
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ";voiViIT
Street_ -
Location and Legal Description Lot_.. _- __ ......... __________ — Block_ 7 .S _. -._ Subdivision ------------.._._._---------
Street and Number where work is to be erformed- No_ - $ 2 Z �. rl�
P �'- t�et_.. ---
State work to be performedd and purpose of building (By Floors)
New Building Remodeling___ -- ---- -___ -- Addition- - -__ -- Repairs No. of Stories . . . ................ ......
Sires Septic Tit.. - � TY e Tank A O
Feet of Drain Tile
Nature of Water Supply: _Dist. Feet of T:. . Drain Field from Well.,
1 . Cit Well. Soakage t
PP Y' Y-
Amount of Permit $___ _ ...... - - - - -- _— __.____ -- - — (Signed)
Capacity Gals
Date
Street
- -- ~ - - - My Commission Expires Notary Public, State of Floreda
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his,6'bligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, 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 h:m 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
requires" by tie Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. (1)
(Signed) - -- `
Master Plumber.
STATE OF FLORIDA, I es.
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when ouch re- inspection is made' necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER!
LAVA
TORIES
SINKS
SLOP
$INKS
LAUNDRY
TUBE
URINALS
CATCH
B ASIN
FLOOR
DRAIN
DRINKING
FOUNT'
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
Hr4TER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/ ,G
---
Permit No.
Employing Plumber's Name
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.
Owner's Name and Address e _�� --------------- _ - __ -- No._
Registered Architect and /or Engine
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ";voiViIT
Street_ -
Location and Legal Description Lot_.. _- __ ......... __________ — Block_ 7 .S _. -._ Subdivision ------------.._._._---------
Street and Number where work is to be erformed- No_ - $ 2 Z �. rl�
P �'- t�et_.. ---
State work to be performedd and purpose of building (By Floors)
New Building Remodeling___ -- ---- -___ -- Addition- - -__ -- Repairs No. of Stories . . . ................ ......
Sires Septic Tit.. - � TY e Tank A O
Feet of Drain Tile
Nature of Water Supply: _Dist. Feet of T:. . Drain Field from Well.,
1 . Cit Well. Soakage t
PP Y' Y-
Amount of Permit $___ _ ...... - - - - -- _— __.____ -- - — (Signed)
Capacity Gals
Date
Street
- -- ~ - - - My Commission Expires Notary Public, State of Floreda
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his,6'bligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, 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 h:m 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
requires" by tie Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. (1)
(Signed) - -- `
Master Plumber.
STATE OF FLORIDA, I es.
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when ouch re- inspection is made' necessary by improper notice for inspection, or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit N® f : /9 .5
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
cf 'Mimi Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
;ridding during progress of work.
Ofs Name and Address _ - _� No.__ /° `�`� W eet ��
- n
Registered Architect and /or Engineer_______— ______________ _-- .____.._
Employing Plumber's Name.__ �� Q No._.___ / _ Sti e! Location and and Legal Description Lot---------- ___ _ -- z Block • d- Subdivision. -- - ____ -- --- _-- _- .
Street and Number where work is to be performed —No / 5 — 1 5 Al a, ,?/ /- -e Street
State work to be performed and purpose of building (By Floors)_ ----- - - - - --
New Building__________ --- Remodeling_ _.. __ —__ Addition..- -__ Repairs
Size Septic Tank..- •- ___ - -- _.- ___ - -- ._Type of Tank
Capacity Gals
Feet of Drain Tile_ ------------------- •----- - - - - -- --Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: ell.__- -- _---------- ____ -_ ____ Size of Soakage Pit
Amount of Permit $ �y
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts l obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supp' 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 such public notce or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, p
COUNTY OF DADE. j
( Signed)
Before ma, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well Town, 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.
My Commission Expires Notary Public, State cf Florida
No. of Stories.
NOTE: A re- inspection 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.
CLOSETS
B ATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
14.Y/
(
/� T TOTAL
fi r✓ /
7�
FIXTURES
C Li
ffl
--
CNECx
-
_' --
SEFTIC
YANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHRCK
^-- - ,__
- - --
-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit N® f : /9 .5
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
cf 'Mimi Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
;ridding during progress of work.
Ofs Name and Address _ - _� No.__ /° `�`� W eet ��
- n
Registered Architect and /or Engineer_______— ______________ _-- .____.._
Employing Plumber's Name.__ �� Q No._.___ / _ Sti e! Location and and Legal Description Lot---------- ___ _ -- z Block • d- Subdivision. -- - ____ -- --- _-- _- .
Street and Number where work is to be performed —No / 5 — 1 5 Al a, ,?/ /- -e Street
State work to be performed and purpose of building (By Floors)_ ----- - - - - --
New Building__________ --- Remodeling_ _.. __ —__ Addition..- -__ Repairs
Size Septic Tank..- •- ___ - -- _.- ___ - -- ._Type of Tank
Capacity Gals
Feet of Drain Tile_ ------------------- •----- - - - - -- --Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: ell.__- -- _---------- ____ -_ ____ Size of Soakage Pit
Amount of Permit $ �y
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts l obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supp' 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 such public notce or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, p
COUNTY OF DADE. j
( Signed)
Before ma, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well Town, 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.
My Commission Expires Notary Public, State cf Florida
No. of Stories.
NOTE: A re- inspection 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.
Date
Septic Tank
Plumbing
Interceptor
Bldg. PET.
Soakage Pit
Well
OWNER
Lay.
COi TENT:
Zone
DADE COUNTY ZO1'IivrG & BUILDING DEPART1 ENT
DIVISION OF PLIT1 3TNG INSPiCTION
195
Tub
Shower
Sink
Water Closet
Urinal
Laundry Tray
Floor Drain
Slop Sink
Washer
Dishwasher
Drinking Fount.
Disposal
Safe Wastes
Pot Sink
Total Fixtures
CLERK
Subd.
Address of Job
Plumbing Installed by Lot
Septic Tank Installed by Block
Interceptor Installed by
Well Installed by H.P. Size of Tank
Soakage Pit Installed by
BUILDING HAS: Stores Offices _Apts.
USE OF BUILDING
Signed
Contractor
Water Service
Elec -Gas Heater
Sewer
Block Drain
Gr...Int.
Gas Outlets
Swim ing Pool
Roof Dr.
Area Drains
FRE
Inspector
_Motel Rooms Bed Rooms
INSP. DATE
Interceptors
Rough Gas
Final Gas
Ground
Rough
Shower Pan
House Sewer
Area Drains
Final Plumb.
Map No.
Mechanical Plan (othersido)
t
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 7350
Work to be performed under this Permit
B1
DATE 195
Contractor's
License No.
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may bo revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY:
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all orc.inancos and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
BUILDING ❑
MIAMI SHORES VILLAGE. FLORIDA
ELECTRICAL ❑ DATE 195
PLUMBING ❑ PERMIT N9 7 8 9 2 Contractor's
License No
' ROOFING ❑
❑ Work to be performed under this Permit_
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
3q. Ft
Value of
Project $
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device di scribed in the application
berefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permi': may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the 01 dinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assur is responsibility for work
done by his agents, servants or employees.
Signed: BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities o Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTH DUTY
New Building
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 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.
Otiwner's Name and Address
Registered Architect and /or Engineer . —_ � ____�___ y
Employing Plumber's Name V'� il_� -_`_re lel__I ` �_2__ _ � 0 .__1 � ® s� — Street �_�9�� d. �`�_ d ��
Location and Legal Description Lot_ Block-
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)._
Size Septic Tank _ Type of Tank _ Capacity Gals
Feet of Drain Tile.— _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—V _..Size of Soakage Pit
- - - - - -- _ _ -- -- o
Amount of Permit $
Remodeling
9AMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN':"
PPLICATION FOR PLUMBING
C1
No. -1 0 _ -e__ Street E
Addition._______._ Repairs No. of Stories_ ... .............
(Signed)._
Street
Date i p - 7 -
Subdivision.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Per anent Supplement, and bus cm-
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 such public notice or notices as are
required by die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
lioenzeol by Miami Shores Village. ' C� r - iyy ,ii cf 5, f' j
(Signed). - -- G '_
Master Plumber.
STATE OF FLORIDA, I
COUNTY ®F 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 he 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
r
Plumbing Inspector.
NOTE: A re- inspection 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.
CLOSETS
BATH
TUBE
S
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N8
TOTAL
FIXTURES
CONTR.
LIST
CMIT.Ctt
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CNC=
New Building
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 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.
Otiwner's Name and Address
Registered Architect and /or Engineer . —_ � ____�___ y
Employing Plumber's Name V'� il_� -_`_re lel__I ` �_2__ _ � 0 .__1 � ® s� — Street �_�9�� d. �`�_ d ��
Location and Legal Description Lot_ Block-
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)._
Size Septic Tank _ Type of Tank _ Capacity Gals
Feet of Drain Tile.— _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—V _..Size of Soakage Pit
- - - - - -- _ _ -- -- o
Amount of Permit $
Remodeling
9AMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN':"
PPLICATION FOR PLUMBING
C1
No. -1 0 _ -e__ Street E
Addition._______._ Repairs No. of Stories_ ... .............
(Signed)._
Street
Date i p - 7 -
Subdivision.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Per anent Supplement, and bus cm-
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 such public notice or notices as are
required by die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
lioenzeol by Miami Shores Village. ' C� r - iyy ,ii cf 5, f' j
(Signed). - -- G '_
Master Plumber.
STATE OF FLORIDA, I
COUNTY ®F 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 he 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
r
Plumbing Inspector.
NOTE: A re- inspection 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.