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1177 NE 91 Terr (6)MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN APPLICATION FOR PLUMBING VMIT Permit No Date 411 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. I �. Owner's Name and Address I►2K__s__ _�.€_ WEA.L.6 No._U?'____ N! € i Street___/ -_- . TRRAC p Registered Architect and /or c _ . ___ ____.-----__--------------- -- --- ---- -- __ ____ -- � - Employing Plumber's NameioeRh BL OCJ ! �'y r a 13 3 r_ Street " Location and Legal Description /17 __ 4 Blloc / k _ Street and Number where work is to be performed —No 7 &I re. State work to be performed and purpose of building (By Floors)._ New ......... - - - - -__ Remodeling —_ -- __ Addition Amount of Permit $ -- - - - --- STATE OF FLORIDA, COUNTY OF DADE. j (Signed) _ ubdivisio Street__ Y/ 1 ARRfiCr Repairs No. of Stories Size Septic Tank_ ----------------- - - -- J — Type of Tank_— Capacity Gals Feet of Drain Tile 1 LL` --Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ __._Size of Soakage Pit - - - -- -- - ..._----------- - ---•• 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 5968, Compiled General Laws of Florida Pe n ent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor - ployed by him in the work to be perfonned under this permit; and will post or cause to be posted' for inspection on the site of the work h 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 permit, as are licensed by Miami Shores Village. Q � Y �/ (Si Ak !L©K 4`Zf Pc , iAbeeb 2 a /A.4 Ri96002. Master Plumber. 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 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. CLOSE TUBS BATH TUBE LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHICK - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G P001. CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN APPLICATION FOR PLUMBING VMIT Permit No Date 411 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. I �. Owner's Name and Address I►2K__s__ _�.€_ WEA.L.6 No._U?'____ N! € i Street___/ -_- . TRRAC p Registered Architect and /or c _ . ___ ____.-----__--------------- -- --- ---- -- __ ____ -- � - Employing Plumber's NameioeRh BL OCJ ! �'y r a 13 3 r_ Street " Location and Legal Description /17 __ 4 Blloc / k _ Street and Number where work is to be performed —No 7 &I re. State work to be performed and purpose of building (By Floors)._ New ......... - - - - -__ Remodeling —_ -- __ Addition Amount of Permit $ -- - - - --- STATE OF FLORIDA, COUNTY OF DADE. j (Signed) _ ubdivisio Street__ Y/ 1 ARRfiCr Repairs No. of Stories Size Septic Tank_ ----------------- - - -- J — Type of Tank_— Capacity Gals Feet of Drain Tile 1 LL` --Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ __._Size of Soakage Pit - - - -- -- - ..._----------- - ---•• 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 5968, Compiled General Laws of Florida Pe n ent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor - ployed by him in the work to be perfonned under this permit; and will post or cause to be posted' for inspection on the site of the work h 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 permit, as are licensed by Miami Shores Village. Q � Y �/ (Si Ak !L©K 4`Zf Pc , iAbeeb 2 a /A.4 Ri96002. Master Plumber. 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 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.