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1192 NE 91 Terr (5)Permit No 02 2 Amount of Permit $ 2 5. 0 0 My Commission Expires 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 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 Cr a h l e N 1192 Registered Architect and /or Engineer login; Plumber's t�iaalo AO rth D ari e S p r t i rpc N o , 800 N W .�...,, Iws._111 S t ... y j 4 // O don a t�sctiption Lot.E / i nZ. - 41 14 i 1 Subdivision / Street and Number where work is to be performed -No 11 9 N 91. Terr Street. State work to be performed and purpose of building (By Floors ) __.__- New Building - - -_ -- - - -• -- Remodeling__- ____..._._- Addition --- _..- _ -..._- Repairs No. of Stories Size Septic Tank— _Type of Tank —_ Feet of Drain Tile 200 so f t DI Feet of Tank or Drain Field from Well____ ___________ .... _ Nature of Water Supply: City-WeUL Size of Soakage Pit (slgaedi • Leverock -- - - - - -- 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 5988, Compiled General Laws of Florida Permanent Supplement, and hie com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wore to be performed under this permit; and will post or cause to be posted' for inspection on the site e work such public or notices as RIP required by the Act. The undersigned agrees to employ only such sub - contractors, 7i� be perf this , KS are licensed by Miami Shores Village. (Signed) Date..._.._.. -.L -. _...._ . -_... S N F. 91 Terr Notary Public, State of Florida Plumbing in vector. Plumber. STATE OF FLORIDA, i µ 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 be 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. NOTE: A re- inspection fee of $1.00 will be made when awe srispaotlos Is mode. asossem by improper notice for Impection, or faulty materials and /or workmanship. CLOSETS BATH TU•S eHOW [Ra LAVA TORIES SINK• SLOP SINKS NDR LAU Tuaa URINALS CA TC H SA a1N FLOOR GRAIN DRINKING FDUNT'NS TOTAL PIITUR[S CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR M[AT[R CUP WELL 5 SYST[N IWIN'O POOL CONTR. LIST CHECK Permit No 02 2 Amount of Permit $ 2 5. 0 0 My Commission Expires 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 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 Cr a h l e N 1192 Registered Architect and /or Engineer login; Plumber's t�iaalo AO rth D ari e S p r t i rpc N o , 800 N W .�...,, Iws._111 S t ... y j 4 // O don a t�sctiption Lot.E / i nZ. - 41 14 i 1 Subdivision / Street and Number where work is to be performed -No 11 9 N 91. Terr Street. State work to be performed and purpose of building (By Floors ) __.__- New Building - - -_ -- - - -• -- Remodeling__- ____..._._- Addition --- _..- _ -..._- Repairs No. of Stories Size Septic Tank— _Type of Tank —_ Feet of Drain Tile 200 so f t DI Feet of Tank or Drain Field from Well____ ___________ .... _ Nature of Water Supply: City-WeUL Size of Soakage Pit (slgaedi • Leverock -- - - - - -- 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 5988, Compiled General Laws of Florida Permanent Supplement, and hie com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wore to be performed under this permit; and will post or cause to be posted' for inspection on the site e work such public or notices as RIP required by the Act. The undersigned agrees to employ only such sub - contractors, 7i� be perf this , KS are licensed by Miami Shores Village. (Signed) Date..._.._.. -.L -. _...._ . -_... S N F. 91 Terr Notary Public, State of Florida Plumbing in vector. Plumber. STATE OF FLORIDA, i µ 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 be 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. NOTE: A re- inspection fee of $1.00 will be made when awe srispaotlos Is mode. asossem by improper notice for Impection, or faulty materials and /or workmanship.