1165 NE 91 Terr (4)BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE. FLORIDA
❑ DATF "
PERMIT N? 6980
Owner of
Building t.
Architect
Contractor
or Builder ° ' ; ' 4.
Legal Lot
Description Bl
Address of
Building ii ±. ;
CONTRACTCR OR BUILDER
Contractors
License No.
Work to be performed under this Permit
195 __..
Subdi-
vision
Value of ! ; Amount of / ` - --
Project $ ! 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 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 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 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
•moo-
CLOSETS
BATH
TUBS
""E" 4WERS
LAVA-
TORIES
SINKS
SLOP
/INKS
LAUNDRY
Tue.
URINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONT •
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
stw M•G
P OL
CONTR.
LIST
` - -'
CHECK
'✓
Permit No ' -
Application is Hereby made for the approval of the detailed statement of ii
structure herein described. This application is made in compliance and co,-"
and all provisions of the Laws ::f the State of Florida, all ordinances of Mix: :
of WPM: Shores Village sh :l1 be coLiplied with, whether herein specifre ..
building during progress of work.
Owrez's Name and Address
Regis; red k-dLect and /or Engineer .....
__
Employing Plumber's Name PA t ic' (iY/s No.__.. I_'
. Subdivlsion .......
_ - . --
• street
State work to be performe8 and purpose of building (By Floors .ro4t.
Location and Legal Description Lot._.__.._
Street and Number where work is to be performed —No
New Building ----- •- - - -• -. - _ - -_ -- Remodeling __ —___ Addition._
Size Septic Tank
Feet of Drain Tile._
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VI:.
PLUMBING INSPECTION DEPARTM':•:' •
APPLICATION FOR PLUMBIN'
00Y41:7_
Data / 11,11 k 7 ./ i 1 )
•, ,ns and spec &.r'.:utions herewith submitted for the b or other
with the Ordinance of Miami Shores Village Florida,
s,res Viva:• u.tu all rules and regulations of the Buildin..; Division
,4. cop; { ^approved plans and specifications must be kept at
-Type of Tank
-.Dist. Feet of Tank or Drain Field from Well .-•---------- _.. -_ - - --
__ Size of Soakage Pit
(Signed)-
(Si
4/6 - -- - Street_ , v y
Street.
Capacity Gab.
My Cowalission Expires Notary Public, State of Florida
Repairs No. of Stories.
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 5968, Compiled General Laws of Florida Permanent Supplement, and bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contr .- s 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 ork such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contra • on work • • . • rm un • this permit, as are
bead by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
;iefore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
tc ne wc.4 kuo ?Jn, and who, being by me first duly sworn, upon oath deposes and says that he is the..
described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
6 :'eex ii `^.y him stated are true.
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.
c - p7
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