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825 NE 91 Terr (6)Legal Description 2 / Architect /Engineer Bonding Company Mortgagor PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ///a.1/9,2), Job Address R-a1$ Al. f'. 9/ w -1 4 144)e 2 Owner / Lessee / Tenant h p-f o 1 y Owner's Address g as. /v- E' 9 1 Contracting Co.go3A. ZFo f #. QualifierM.4X,,e , , p�i ve HT,ody State # 93' o9'9 Municipal # 9,a , Permit Type(circle one): BUILDING ELECTRICAL Ju = Tax Folioji/ J I � e2 - P P i Master Permit _ - Phone Address 71/0 N. e ,.tK - / Phone 9 . r -iii 3 I Competency #k( OS.S89 )Ins.Co. e 0 1 0 1,),:q Address Address Address MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION G ee_ I9r Al .e ld /gyp 41 4 ) S y Cr "' Go 6e' / •- /( wII( 6 e A 30o f► / Estimated Cost(value) o 1 ;5coo 0 , Square Ft. 3 0 0 1 WARNING TO OWNER: YOU MUST RECORD 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, 1 autho -ize ti-- abo a -named ` :•ntractor to do the work stated. 1116r: 7 JOSEPHINE CHURCH c ! %. .i eat Exil konl 30, N 6019756 Signature of Date: 11' owner and a-- - "074,-1.4'e/ i ��< t c u{sram Mme of Rotary Pu tarysas to Owner and /orpc gp9kk� , ltrocluced y Commission Expires: Type and nuc . produced: ❑ DID take an oath, or ** * * * * DIR NOT take an o#h. FEES: PERMIT APPROVED: Zoning Mechanical Fire lumbin * * * Signature of Contractor or Owner - Builder Date: NOTARY Y COMMISSION EXPIRES: Sept. Sept. 29, 199S. ���°Z9� BONDED THRU NOTARY PUBLIC UNDERWRITERS. Q LL A.I i ( .G - Notary as to Contractor or Owner- Builder My Commission Expires: OBI RADON C.C.F. 1 e 0 D NOTARY - - ©° TOTAL DUE (-1' Other Building Electrical Ei?gineering butL tv Chapter 181, F. S , F NOTE EXP:E ONE YFkH F :21 MO L NC.:T . REPAIR PERJ AND HOLI.:;! NG TANK PERMI 'i E XPI RE F1 CA . rc_ APPROvi'L OF A ::SYSTEM DO; NOT GU LEE CATT.SFAcrC KoR T OF TTME TO DE COMPLETED 1 APBUf_CANT7_ 7-')s 7 • 4 /3 ) (Home) Owne s ;via ti trig Addr6L:t; Owne s !Agent 7 Jit! r ote Agent's Mailing Address: Property Street Address: Exact Directions tc Property: B a 7(F f,e/ V 67. j al, ca • • • a a, a ra• . • ( 1.• a, aaav ara an• a. ea • a a ■-• ir Lot Block 4 1 i r D a t e -------- • Sect Township: Ranc;e Parcel #: o.uicj DJ9tior Property Siz ( Wster Supply : !vats [ 1 Is S.snitoxy Is t-,3h • Commerr ,:.. (c.tzr - Signature: rATP PLI:2")A-MMEN'T: fl i; ANr '.!-IAR SERVICES 1 •!!;1 M PERMIT ..----- • ; 1 P s:; . 1„...--r :1' ,.i.pl:aticrt ReE„eiv:"..L1 . ' •...E.; ! 11. ::,), 7 ' eni ', l ' t...*:<poru-;r o :. - • i em f ) 1 '''..'-,k kba tV;o u ;-, ;... P c.f. i Li. . 4'.../( • ' . - _::.e._:•._n? ':' - ( (pc L i MA A rafft.1 Sq /Ar res Tc h - Lim! t i2J Us t-' [ 1 Bulidlng A 31T f ?room' Bui1dinq Permit #: _ •t .fln/PeittI.t. it: t _ Zip: :4 3, Te :tc icW)jJ H) 3/J4 2 C , ity:1V- a-I _ Zip: " - .:. i.TAtE. t n7 .• I . ' • : to the se - 1 ! ) - .ne 4C' ' -,_'; N,',;E :• . '. • : ;_: to the se 1..".n. ---...— g •;' Hours Opeiati „1_,. 7- 4 • Plumbing Grinders/0 i cposa ls „ns Drains 1_!'cra-l.ow Volume Flush Toilets _ BUILDING PLAN .s'7" ATACt I: SHOW NC CFFICE5 , , ;DROOMS, TOTAL BUILUY EA, AND PERTINFNT FEA'r "-U.C.' :Ase T1: 1n-6, F . C. IN ADDITION, A D' r TE PLAN AND/OR SURVEY, LH, NUE- AT4CHEr, S PROPERTY DIME. :1,DING • • LOCATIONS, AND PF',7 • TO BE c3UHM rTTED PER CRAM 6 F.A.C. L t 's ' By "L\ Plan Approved L.()T11[ DEPP7MEr - 17,ALTI - 1 AND REHABIL7A SERVICES E S vr: A C2 ' . . , 0 N rEMrr p 0r' Numt , !e 11 tduck rep! and 1 50 e;,.i. ' Site Plan submitted by: _ V_ ron (Choc' AiI froyinigi Ucitilonu) LIP Ncit Approved ALL CHANGES Mur; fiE AF-'A(JVE0 LW THE COUNTY PUBLIC HEAL': FOR OPTIONAL USE AS AN ATTACHME ts t TITLE Date P ubl i c I .‘i 4015 • Ui4;iI1 E SLWAUL DIS1'USAL SYt; ILIA • CONSTRUCTION INSPECTION AND APPROVAL /�� epuctlon floquoslod �� /a 3 j 7-1' Appficatlon /Pormh Numbor �o spoctlon Performed 77- ! / 5'-'-''- •oporrty Owrior: r +`j 07" /-/ 0 Lot: !Block: SutxlMalon: Unit:__ - oporty Struot Ad,droae: '`/4=:•• / S f T---1 Section: Township: flan9o: I'arcol: .nndonmonl: Tank Pumpocf /, /,' Crukhod and Flied / / Approvrrd by: i' /4 stollur: GG /_! /L�' -' /,� 5 «G C_. Approvod: Yee_ No ,. ; _ floulstrallon #: r.., r ink Sizo�s): /_ ,' ' .--f potions Tank Material: C,� in Uetfte Itequlrod'.'Yoa No : ,' Installod: Yoe / No !oporLupond: Yos No t'/ - Levu!: Yee No__ Yee No ,,, !.t Outlet Dovlco: Yoe__ No_ kcavatlon &.FWl a3 No Tuqulrod: ea ___. o System el 'proper elevation: - No f,„/_-_ Fill , I Adoquate: Yos , No isorpllon woo adoquato: Yee s ue- Nu Amount of Dralnfloid Installed: Squnro Foot stallod.in ; Tronchus Absorption Bed L / Olher(deecrlbo) System !ocelot' ea porrnhtod: Yee ,,...--- No All solbacke malntnlnod as roqulrod: Yos (...../. No Wull 8otback • , /ii Fl Wator Lino Solbnck Proporty Llno 3 otba &k / ; Ft Foundation Solbnck Surfaco Wator Sotback 7 ,, - , Ft Dralnnpo Setback Approunto Suheblu: Yee e ms-- No DOT Grath) rV: , Amount() Doplh: Minimum: Mnxlrnurn: ; Y Dralnliold Dirnonalons: 7 / X EASE PROVIDE A SKETCH Of Tilt 5 YOTEM (AVOUT IrI E APPfIOXIMATL All EA WIIERL' IT WA3 COH i1IlUCTr:O DIFFEREtIT FH0h1 SITE PEAL. Jclltlonal Cornnlunls: 7- C� ;'' % C ) MOUND & FILLED SYSTEM INSPECTION rstom stabilized Yos No Ghouidets Adequate: Yoe No Slopoe Adogt.lato: Yos No aprovod StubIllzotlon Malorinl: Yos No GtabllIz lion MnI�n& Uaud: onstructton Status: Isapprovod: Dnto: / / 'Monson: Isupprovud: Dtto: / onstnrctIon Approvod: Uy: Innl Systcrn Approval: r/ ll y:_ Ronson: Numbnr of Unoa: Length 'of Tinos: . -.. Ft Ft Plpo sopnrnllon OI< :Yua � Proper slope: Yos No_ Distribution Llox /11oajf Pipe- Lovol: Yos No Unobelruclod nroa io ifili J — Sq Unobutructod aroe avenablo: - S Doplh of Covor Malorinl: Inches I Wator Alarm: Pump Size: Construction Stutua:Dlkapprovod Data / / Ronson: Construction Slntua:D(anpprovod Dolo / / Ronson: Construction Approval: Yus ,i No c.__. CI 11' Uy: F / • Date: // • CPI 1U Date FINAL INSTALLATION APPROVAL .rildlnj Aroa: Square Foot Numbor of Bedrooms: - . • Numbor of Units: 'ell locutions proper: Yua No Dralnngo Structuros Localo.d Proporly: Yoe No nal Systorn Approval Status: Isopprovod: Milo: / / Ronson: CPIIU Y: Isepprovurl: Date: / ) Monson: Y: _ CPIIU utnspuctlon Foes Paid: Yua No N/A Duto Pak" / / Amount loo Paid: =�`; CPI (U Data / /�4/ Permit No. 7 7 ? o 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 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 No. Street_ Registered Architect and /or En i er Employing Plumber's Name Size Septic Tank Feet of Drain Tile A, Nature of Water Supply: City —Well STATE OF FLORIDA, } COUNTY OF DADE. Amount of Permit $ —� - My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEi '' APPLICATION FOR PLUMBING Addition 7aCe No Location and Legal Description Lot________. .. "___.. .—__ B1 _ Subdivision Street and Number where work is to be performed— No.__ t State work to be performed and purpose of building (By Floors) New Building _ Remodeling - - - -- ______ (Signed)_ Repairs Street Capacity Gals._... ._Size of Soakage Pit un�ing 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 Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and leas 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. ( Signed) - - - 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 No. of Stories . . . ...................... Master Plum er. 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 Tuns S LAVA- TORIES INK SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HLVrER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No. 7 7 ? o 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 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 No. Street_ Registered Architect and /or En i er Employing Plumber's Name Size Septic Tank Feet of Drain Tile A, Nature of Water Supply: City —Well STATE OF FLORIDA, } COUNTY OF DADE. Amount of Permit $ —� - My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEi '' APPLICATION FOR PLUMBING Addition 7aCe No Location and Legal Description Lot________. .. "___.. .—__ B1 _ Subdivision Street and Number where work is to be performed— No.__ t State work to be performed and purpose of building (By Floors) New Building _ Remodeling - - - -- ______ (Signed)_ Repairs Street Capacity Gals._... ._Size of Soakage Pit un�ing 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 Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and leas 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. ( Signed) - - - 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 No. of Stories . . . ...................... Master Plum er. 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. 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. ' Owner's Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 7 , No. No.________________ Street Date /° Street Location and Legal Description " ot_-___. ._ ......... _________... Subdivision Street and Number where work is to be performed -No._- 2- S _9 / - Street State work to be performed and purpose of building (By Floors) N B __ Remodeling.___ -_ - _________ Addition 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 Nature of Water Supply: it Well ----------- _- _--- .- ___ -__ Size of Soakage Pit Amount of Permit $ (Signed)_ 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 5988, 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. (Signed)._ (� 9 Master Plumber. 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• re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials d/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS RINALS BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST / I f /f �-e � /<To / /� (� / . -- CHECK /� 7 ( 0 .1 � �^ ...5' SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP fretslen HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL __1 4 OG kJ 3 7,r ' _L______ ' /. COHTR. LIaT / / 6 CHECK — U ?) 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. ' Owner's Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 7 , No. No.________________ Street Date /° Street Location and Legal Description " ot_-___. ._ ......... _________... Subdivision Street and Number where work is to be performed -No._- 2- S _9 / - Street State work to be performed and purpose of building (By Floors) N B __ Remodeling.___ -_ - _________ Addition 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 Nature of Water Supply: it Well ----------- _- _--- .- ___ -__ Size of Soakage Pit Amount of Permit $ (Signed)_ 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 5988, 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. (Signed)._ (� 9 Master Plumber. 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• re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials d/or workmanship. ) 44 • 2 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. ` ,L 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 of Miami Shores Village shall be complied with, whether herein specified or A copy of approved plans and specifications must be kept at building during progress of work. ee) Owner's Name and Address _ ___ _�L��p � ' � �• No._ Street Registered Architect and /or En rear Employing Plumber's Name f` L � . t OJ 411>k- Location and Legal Description Lot_ ___________ Subdivision Street and Number where work is to be performed— No._____ _S-2_ 6S Street.__ Street State work to b e performed and purpose of building (By Floors)___..- 0 6 , 422-- - ) J New Building Remodeling____ ______ Addition________.______________ Repairs G No. of S •ries Size Septic Tank — Type of Tank_____ Capacity Gals. i Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ Size of Soakage Pit Amount of Permit $ The undersigned applicant for this building permit does under the Florida Workmen's Compensation Act, being Section 5988, plied with the provisions thereof, and will require similar compliance from all con performed under this permit; and will post or cause to be posted' for inspection on the site required by tlie Act. The undersigned agrees to employ only such sub - contractors, on licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. j My Commission Expires Plumb Spector. accepts his obligations as an employer of labor lorida Permanent Supplement, and has corn- sub-contractors employed by him in the work to be f the wor such public notice or notices as are ork to b performed under this permit, as are 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 abov1described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by m stated are true. Notary Public, State of Florida Master Plumber. OTE: 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 SINK6 SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST - -- CHECK 44 • 2 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. ` ,L 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 of Miami Shores Village shall be complied with, whether herein specified or A copy of approved plans and specifications must be kept at building during progress of work. ee) Owner's Name and Address _ ___ _�L��p � ' � �• No._ Street Registered Architect and /or En rear Employing Plumber's Name f` L � . t OJ 411>k- Location and Legal Description Lot_ ___________ Subdivision Street and Number where work is to be performed— No._____ _S-2_ 6S Street.__ Street State work to b e performed and purpose of building (By Floors)___..- 0 6 , 422-- - ) J New Building Remodeling____ ______ Addition________.______________ Repairs G No. of S •ries Size Septic Tank — Type of Tank_____ Capacity Gals. i Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ Size of Soakage Pit Amount of Permit $ The undersigned applicant for this building permit does under the Florida Workmen's Compensation Act, being Section 5988, plied with the provisions thereof, and will require similar compliance from all con performed under this permit; and will post or cause to be posted' for inspection on the site required by tlie Act. The undersigned agrees to employ only such sub - contractors, on licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. j My Commission Expires Plumb Spector. accepts his obligations as an employer of labor lorida Permanent Supplement, and has corn- sub-contractors employed by him in the work to be f the wor such public notice or notices as are ork to b performed under this permit, as are 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 abov1described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by m stated are true. Notary Public, State of Florida Master Plumber. OTE: 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. Permit No .S Size Septic Tank._ _ -- Feet of Drain Tile_ . - ___ _- - -- -- Nature of Water Supply• City —Well. STATE OF FLORIDA, as. COUNTY OF DADE. 1 06 Owners Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name i _i_t_t _ No. . Type of Tank __ __Dist. Feet of Tank or Drain Field from Well.. _ Si .0. of Soakage Pit - (Signed) _ ._ S 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 build ng or other structure herem 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 th Building Div Sion of Miami Shores Village shall be complied with, whether herein specified or not A copy of approved plans and specifications must be kept building during progress of work. i The undersigned applicant for this building permit does hereby certify that he understands and accepts his obhgatio under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent plied with the provisions thereof, and will require similar compliance from all contract ntractors emplo performed under this permit; and will post or cause to be posted' for inspection on the site of the ork such p required by the Act. The undersigned agrees to employ only such sub- contractors, o work to be perfo. licensed by Miami Shores Village. ZS_ - --- Street_ A11.1477 CP, e" • No 1 _ Street _ Capacity Gals. Location and Legal Description Lot________ ___ __ ______ ________ _ _ __ Block__ __— _ Subdivision.._ Street and Number where work is to be performed— No._— _— ___�. `') Street _ 71 - State work to be performed and purpose of building (By Floors) _ . .� mod- j� _ .dg .2_ . - New Building Remodeling________ __ __ __ _ _ Addition____ _'_ ____ - _ Repairs_ �- No. of Stories c9 / Before me, the undersigned authority, a notary public, duly authorized to administer oath and take acknowledgu ents, personall appeared My Commission Expires Notary Public, State of Florida P n lag In.pec:to as an employer of labor ^nil I as • om- the woI k to be no ices as are nit, as are 7 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 apphcation, and that he did sign the same, and that all .acts 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 worlonanehip. CLOSETS BATH TUB6 SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS U CATCH BASIN FLOOR DRAIN DRINKING FOU'T'NS TOTAL F XTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WE_L SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Permit No .S Size Septic Tank._ _ -- Feet of Drain Tile_ . - ___ _- - -- -- Nature of Water Supply• City —Well. STATE OF FLORIDA, as. COUNTY OF DADE. 1 06 Owners Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name i _i_t_t _ No. . Type of Tank __ __Dist. Feet of Tank or Drain Field from Well.. _ Si .0. of Soakage Pit - (Signed) _ ._ S 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 build ng or other structure herem 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 th Building Div Sion of Miami Shores Village shall be complied with, whether herein specified or not A copy of approved plans and specifications must be kept building during progress of work. i The undersigned applicant for this building permit does hereby certify that he understands and accepts his obhgatio under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent plied with the provisions thereof, and will require similar compliance from all contract ntractors emplo performed under this permit; and will post or cause to be posted' for inspection on the site of the ork such p required by the Act. The undersigned agrees to employ only such sub- contractors, o work to be perfo. licensed by Miami Shores Village. ZS_ - --- Street_ A11.1477 CP, e" • No 1 _ Street _ Capacity Gals. Location and Legal Description Lot________ ___ __ ______ ________ _ _ __ Block__ __— _ Subdivision.._ Street and Number where work is to be performed— No._— _— ___�. `') Street _ 71 - State work to be performed and purpose of building (By Floors) _ . .� mod- j� _ .dg .2_ . - New Building Remodeling________ __ __ __ _ _ Addition____ _'_ ____ - _ Repairs_ �- No. of Stories c9 / Before me, the undersigned authority, a notary public, duly authorized to administer oath and take acknowledgu ents, personall appeared My Commission Expires Notary Public, State of Florida P n lag In.pec:to as an employer of labor ^nil I as • om- the woI k to be no ices as are nit, as are 7 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 apphcation, and that he did sign the same, and that all .acts 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 worlonanehip.