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Permit No... _ f.__1 '%'
Registered Architect and /or
Employing Plumber's Name -_ - kc. lstf
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 st
building during progress of work.
Owner'! Name and Address ........ _____.._ __ __.__ __ ..__.._. No.. §.. - - :...
�17 o /7/3
Date..._ .. , .---- - - - - -- - - -- - - - -- _ ._
Location and Legal I)escrtption Lot. 81oak_ Subdivision__.- _-_.
Street and Number where work is to be perforrrad --No __!.....e.._./ Str:•at /1- e V e;
State work to be perfonne3.and purpose of building (By Floors) _--____—.-------------- .__._ . _-- -._.. ------ .._..- - - - ._.
New Building Remodeling
Size Septic Tank- 9 0 Type of Tank___________ ........ .- — Capadty Gala._. _... . . . . .....
Feat of Drain Tile .3 0 •"" Dist. Feet of T'ink oe Drain Fled from Well..
Nature of Water Supply: City — Well.- --____- ____ _ _--- __--- ._.Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. I
Is.
Addition_____. ....... Repairs__.__...... . ...... No. of Stories
(Signed)_ —
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob!iyt'ions as an employer of tabor
under the Florida Workmen's Compensation Act, being Section 596+3, 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- eontractcrs 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 rub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. '
(Signed)_.._ V A-'‘-'--- .. _..
MArft Plumber.
Before me, the undersigned authority, a notary public, duly aut mized to administer oaths and take ackk- wwledgnients, personally appeared
to me well known, and who, being by me first duly sworn, Leon oath depoaes and says that he is the of the above described construction, that he has carefully lead the foregoing application, and that he did sign the Eame, and that all facts
therein by hire, stated are true.
My Commission Expires Notary Public, blic, State of Florida
Plumbing Inspector.
NOTE: A re-inspection fee of $1.00 sill be rated wheel rict.h re l speeder.) is wade' rrectsaary by imprC+per notice for inspection, or faulty
materals and /or AKxhoanahip.
MIAMI SHORES VILLAGE
7 PLUMBING INSPECTION DEPARTMENT
0
/3 /SD APPLICATION FOR PLUMBING PERMIT
Permit No � `_ { Date ____
- / - 93
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_ / 4 - 2 - 1 a . - - 4 <_l ? 1 -- - t / r - - - G J �
i No 2s 8 Street i1 ✓_!_r�._._.2t L.<J - --
Registered Architect and /or Engineer —__ t
Employing Plumber's NameC rii, 2r =?c:/0?,,._ s fo. c ., i. /
,,.. ,��
,�: _ _ No 'l /P- Street%1' L C--
Location and Legal Description Lot__________ _______ ___ Block__- ____ -- _- ____ - Subdivision
Street and Number where work is to be performed- No._____ _ r L_� rStreet
Addition Repairs
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Size Septic Tank
Nature of Water Supply: City -Well.
Amount of Permit $ T �
STATE OF FLORIDA, } ss.
COUNTY OF DADE.
- — T - - My Commission Expires
Type of Tank_
of Drain Tile Dist. Feet of Tank or Drain Field from Well
r %_ Si of- soakage Pit
t
1 -
t 0 - o --- - - - - --
- - -- (Si - ____�
No. of Stories. _
Capacity Gals.___ _...
Notary Public, State of Florida
l /...
Plumbing Inspector.
i
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligaf�6ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent 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.
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notica for insp 1, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
Nt��:.)
A. .
CATCH
BASIN
FLOOR
DRAIN
ppg iz,uq
/ Z J u� P I
Cti.1. /JEe
� Ae �
/'
TOTAL
FIXTURES
CONTR.
LIST
-
/
/
/
CHECK
/
/ _-
/
-_
SEPTIC
TANK
SEWER
CONN.
DRAIN
PIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DELP
WELL,
SPRKLR.
SYSTEM
SW IM'O
POOL
<-'4 fe
,c
CONTR.
List
CHECK
/
/
- - --
MIAMI SHORES VILLAGE
7 PLUMBING INSPECTION DEPARTMENT
0
/3 /SD APPLICATION FOR PLUMBING PERMIT
Permit No � `_ { Date ____
- / - 93
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_ / 4 - 2 - 1 a . - - 4 <_l ? 1 -- - t / r - - - G J �
i No 2s 8 Street i1 ✓_!_r�._._.2t L.<J - --
Registered Architect and /or Engineer —__ t
Employing Plumber's NameC rii, 2r =?c:/0?,,._ s fo. c ., i. /
,,.. ,��
,�: _ _ No 'l /P- Street%1' L C--
Location and Legal Description Lot__________ _______ ___ Block__- ____ -- _- ____ - Subdivision
Street and Number where work is to be performed- No._____ _ r L_� rStreet
Addition Repairs
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Size Septic Tank
Nature of Water Supply: City -Well.
Amount of Permit $ T �
STATE OF FLORIDA, } ss.
COUNTY OF DADE.
- — T - - My Commission Expires
Type of Tank_
of Drain Tile Dist. Feet of Tank or Drain Field from Well
r %_ Si of- soakage Pit
t
1 -
t 0 - o --- - - - - --
- - -- (Si - ____�
No. of Stories. _
Capacity Gals.___ _...
Notary Public, State of Florida
l /...
Plumbing Inspector.
i
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligaf�6ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent 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.
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notica for insp 1, or faulty
materials and /or workmanship.
1!
VI/
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