816 NE 91 Terr (3)Permit No- . ,Yof
Application is hereby made for the approval of the detailed etatement of the plans and specifications herewith submitted for the building or other
structure herein described. This application L 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 Hutt be kept st
building during progress of work. �j re / {., Owners Name and Address VA �v No I Stet �/-d� ?Z . t ( t(t
Registered Architect and /or Engineer
M'
Emile $ Plumber's Name
6 -'
1) Y,cca tan annLegal Lot- /e__It_ s- 1 1/ Block ■ 9 �, .S/u�bdiivvfslon,i4ett
a
Street and Number where work is to be performed -No t—' _ Street ... .
State work to be performed and purpose of building (By Floors) _ -._ Fe_% __.2..0 ..1T........ I_ 6(
New Building- ._..-.---- -•- • ..... ......- Remodeling___ —._- Addition.. _. Repair
Size Septic Tank__ -
Feet of Drain Tile.
—
Nature of Water Supply: City-Well.
My Commission Expires
MIAMI SNORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
eGA - +E c�
r E?yp5^t,CT�fa'•'s..d`
Type of Tank_ - - - - --
-- -_Dist Feet of Tank or Drain Field from Well .. ._._--•-----._ - ---------....-----------
Size of Soakage Pit
( Signed)
St/
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 5969, Compiled General Laws of Florida Permanent Supplement, and lid. com-
plied with the provisions thereof, and will require similar compliance from all contractors OT sub - contractors em.Ioyed by him in the wor• to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work f .ublic, notice or notices as are
required by the Act The undersigned agrees to employ only such sub- contractors, on to be '"t / I . this permit, as are
licensed by Miami Shores Village. ' / I/
(Sited) ( � '
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclurowledgments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State el Florida
NOTE: A re fee of 11.00 will be made wine snob rolsapeotfoe V mede•neasserry by improper notice for inspection, ea faulty
materials and /ar workmanship.
CLOSET*
BATH
TUB*
SMOKERS
LAVA-
TORIES
SINK*
SLOP
SINKS
LAUNORY
Tuns
U RINAL*
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
PIaTUAte
CONTR.
LIST
-_
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
S
1 N
*WIN •G
POOL
COPT!.
LIST
-
CHECK
Permit No- . ,Yof
Application is hereby made for the approval of the detailed etatement of the plans and specifications herewith submitted for the building or other
structure herein described. This application L 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 Hutt be kept st
building during progress of work. �j re / {., Owners Name and Address VA �v No I Stet �/-d� ?Z . t ( t(t
Registered Architect and /or Engineer
M'
Emile $ Plumber's Name
6 -'
1) Y,cca tan annLegal Lot- /e__It_ s- 1 1/ Block ■ 9 �, .S/u�bdiivvfslon,i4ett
a
Street and Number where work is to be performed -No t—' _ Street ... .
State work to be performed and purpose of building (By Floors) _ -._ Fe_% __.2..0 ..1T........ I_ 6(
New Building- ._..-.---- -•- • ..... ......- Remodeling___ —._- Addition.. _. Repair
Size Septic Tank__ -
Feet of Drain Tile.
—
Nature of Water Supply: City-Well.
My Commission Expires
MIAMI SNORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
eGA - +E c�
r E?yp5^t,CT�fa'•'s..d`
Type of Tank_ - - - - --
-- -_Dist Feet of Tank or Drain Field from Well .. ._._--•-----._ - ---------....-----------
Size of Soakage Pit
( Signed)
St/
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 5969, Compiled General Laws of Florida Permanent Supplement, and lid. com-
plied with the provisions thereof, and will require similar compliance from all contractors OT sub - contractors em.Ioyed by him in the wor• to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work f .ublic, notice or notices as are
required by the Act The undersigned agrees to employ only such sub- contractors, on to be '"t / I . this permit, as are
licensed by Miami Shores Village. ' / I/
(Sited) ( � '
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclurowledgments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State el Florida
NOTE: A re fee of 11.00 will be made wine snob rolsapeotfoe V mede•neasserry by improper notice for inspection, ea faulty
materials and /ar workmanship.
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ° "
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. J`, �/�, � `-
Owner's Name and Addresse -fro ' /Fl!_Ll L—'l 1 No.- ate Street_ _ /. L
Registered Architect and /or En ineer ..... ___._— _.__......
_
Employing Plumber's Nam r�" _BYE. !� j 'r -_— No._15_ Street___ /2.,.1_ .,ti°`
Location and Legal Description ot_______ _ _� Block
Street and Number where work is to be performed— No.__J11 / _4
State work to be performed and purpose of building (By Floors)
New Building Remodeling_
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
Z
Amount of Permit $
/31 37
Street q1 •
_ Addition Repairs No. of Stories.
Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
(Signed) - =
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract
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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit,
licensed by Miami Shores Village. _ , `•
!g/ieM.,42
(Signed)._
,r.
Date /_4/_f
Subdivision
Plumb g Inspector.
bligations as an employer of labor
manent Supplement, and bus corn -
employed by him in the work to be
as
as
Master Plumber.
are
are
STATE OF FLORIDA,
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.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tune
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL.
FIXTURES
CONTR.
LIST
/
J
CHECK
1
(�a�
J/
/ / .A:
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
COHTR.
LIOT
CHECK
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ° "
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. J`, �/�, � `-
Owner's Name and Addresse -fro ' /Fl!_Ll L—'l 1 No.- ate Street_ _ /. L
Registered Architect and /or En ineer ..... ___._— _.__......
_
Employing Plumber's Nam r�" _BYE. !� j 'r -_— No._15_ Street___ /2.,.1_ .,ti°`
Location and Legal Description ot_______ _ _� Block
Street and Number where work is to be performed— No.__J11 / _4
State work to be performed and purpose of building (By Floors)
New Building Remodeling_
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
Z
Amount of Permit $
/31 37
Street q1 •
_ Addition Repairs No. of Stories.
Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
(Signed) - =
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract
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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit,
licensed by Miami Shores Village. _ , `•
!g/ieM.,42
(Signed)._
,r.
Date /_4/_f
Subdivision
Plumb g Inspector.
bligations as an employer of labor
manent Supplement, and bus corn -
employed by him in the work to be
as
as
Master Plumber.
are
are
STATE OF FLORIDA,
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.
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.
Architect
Contractor
or Builder A
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ` ❑
ELECTRICAL ❑ DATE �� °' 195
PLUMBING 0 PERMIT N? 8204 Contractor's
License No
r 2
ROOFING ❑
❑ Work to be performed under this Permit
Owner of
Building
Bi.
Subdi-
vision
Sq. 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 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
C ONTRACTOR BUILDER BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal Lot Bl.
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N. 4253
Work to be performed under this Permit
Owner of
Building
•
Subdi-
, ision
Value of
Project
DATE 194_
Contractor's
License No
Arnt. 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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 respon-
sibility 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 accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
BUILtING
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
DATE 194_
PERMIT N2 4322
Work to be performed under this Permit
Owner of
Building :r
Legal Lot Bl.
Description
Address of Value of Amt. of
Building v "v Project Permit
This pennit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the p1i-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil be performed in complia e w any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may evoked
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 rich 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 respon-
sibility for work done by his agents, servants or employees.
Subdi-
vision
Contractor's r"
License No u'
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 accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY.
•
BUILDING -
ELECTRlI AL
PLUMBING
Owner of
Building
PERMIT N? 4322
Legal Lot Bl.
( Description
`j Addr ess of •/
sibility for work done by his agents, servants or employees.
MIAMI SHORES VILLAGE, FLORIDA
DATE •. '
•
Work to be performed under this. Permit RJ- ,, -�0 N'
Architect
l Contractor C • ��� � ; ,
or Builder �� � �ti,
Building a Q y1 a t
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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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
!j 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 • the ,fit at ements or specifications and that he assumes respon-
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with Al rdinances and,�.�rregglations"
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authontz s of Miami Shol'es ill ge.
?n accepting this permit I assume responsibility for a work done by eithe myself, my agent, servant of employee.
q
Signed:
Subdi-
vision
CONTRACTOR O BUILDER , •
Value of
Project
.rte
INSPECTOR
� v m
Amt. of
Permit
/ 194``1
Contractor's j , 7e ,
License No
3'
B
AUTHORITY
•
Permit- No /• rC
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.
p
Owner's Name and Address T/ a ° ° " 1j No Street- l ! i o 2, 1
State work to be performed and purpose of building (By Floors)
New Building _14,? Remodeling
Amount of Permit $
ss.
My Commission Expires
APPLICATION FOR PLUMBING PERMIT
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Addition Repairs
(Signed)
Date -- % °
Registered Architect and /or Engineer
�? � / o o lj C' �
Employing Plumbers Name -- r_� _ No._ Street y�!
Location and Legal Description Lot /
Street and Number where work is to be performed— No. - Street_ 2-2)
k No. of Stories - •
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 —Well. Size of Soakage Pit
C 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 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 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 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.
r
( Signed
• l�
STATE OF FLORIDA, 1 /� y
COUNTY OF DADE. 1
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.
Notary Public, State of Florida
Master Plumber.
t--- -4 --
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
T UBS
SHOWERS
LAVA-
TO///���RIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'NS
TOTAL
FIXTURES
CONTR.
LIST
�f
/�/
O
CHECK
S
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
•
Permit- No /• rC
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.
p
Owner's Name and Address T/ a ° ° " 1j No Street- l ! i o 2, 1
State work to be performed and purpose of building (By Floors)
New Building _14,? Remodeling
Amount of Permit $
ss.
My Commission Expires
APPLICATION FOR PLUMBING PERMIT
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Addition Repairs
(Signed)
Date -- % °
Registered Architect and /or Engineer
�? � / o o lj C' �
Employing Plumbers Name -- r_� _ No._ Street y�!
Location and Legal Description Lot /
Street and Number where work is to be performed— No. - Street_ 2-2)
k No. of Stories - •
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 —Well. Size of Soakage Pit
C 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 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 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 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.
r
( Signed
• l�
STATE OF FLORIDA, 1 /� y
COUNTY OF DADE. 1
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.
Notary Public, State of Florida
Master Plumber.
t--- -4 --
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
Tues
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuns
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'S
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEk''
APPLICATION FOR PLUMBING "' ►dvirr
Date_ _.._ A ---- __ ____ -- j ---1
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 nut. A copy of approved plans and specifications must be kept at
building during progress of work.
Permit No - 2
Owner's Name and Address
Registered Architect and /or Engineer
■
Employing Plumber's Name _ "ml __�= :t13{r�
Location and Legal Description Lot. _______
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_
Z?/
r �I
! No. ___ _ � Street_
1 LJ''__ -- No._______.._1
Block_____
Street
New Building Remodeling Addition
Street_.
Subdivision
s
s/
Repairs No. of Stories.... .......... .....
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $
Plum ing Inspector..,
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig&Hons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, 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 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 sue p' lic notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on -work to be for ed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
My Couunission Expires
(Signed)
(Signed) -.. -_ 1. " - O
c.
aster Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaFhs 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.
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.