PLUMBING PERMITBUILDING
ELECTRICAL
PLUMBING
ROOFING
PERMIT N° 6022
0
❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description -
Lot
Address of
3uilding
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
Bl.
DATF 195
Contractor's
License No.
Subdi-
vision
Value of II Amount of
Project $ II 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 prformed 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 sptitements or specifications and that he assumes responsibility fcr 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•
:opting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
—=
CLOSETS
BATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE"
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•G
POOL
CONTR.
LIST
CHECK
1
MOAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r' wMOT
Permit No 0 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'a Name and Address No. ill Street_
Registered Architect and /or Engineer________ -_
G Employing Plumber's Name . y' - ' f___ ._____�._�__.__ No._.= ��_�__ -- ��- - - //,'/
Location and Legal Description Lot-____--_-_--____ Block Subdivision
Stet and Number where work is to be performed—No Street
State work to be performed and purpose of building (By Floors)__
New Building-- -.__ -_ _ -- Remodeling____ _ Addition--- _ -_ -_._ Repairs No. of Stories . . ... ..... ....... ......
Size Septic Tank
Feet of Drain Tile
th ,
Nature of Water Supply: City — Well.__
Type of Tank_____ Capacity Gals.
1 • (LLD st. Feet of T'� or Drain Field from Well - ..------ •------ • - _ - ..._
Size of Soakage Pit
---
Amount of Permit ...... — _-- _ — -- _ — ( Signed)
My CG.:imission Expires Notary Public, State of Florida
z.
Master Plumber.
mbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation s 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
rcq Bred by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
ild by Miami Shores Village.
(Signed)_ � -
STATE OF FLORIDA, as.
COUNTY OF DADS.
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
thirf i 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 workmanship.
MIAMI SHORES VILLAGE, FLA.
JOB 4-r 7'' o ��
ADDRESS / I d C / 2/
INSPECTION
TIME READY
REMARKS:
N9 6610
NSPECTOR 4 DATE 1° °' �J