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PLUMBING PERMITPermit No ('") Owner's Name and Address Registered Architect and /or Engin Employing Plumber's Name Location and Legal Description • t. Street and Number where work is to be performed —No Size Septic Tank___ ......... _______--.... ---- - - - - -- -Type of Tank__ Feet of Drain Tile_—.__ Nature of Water Supply: City—Well Amount of Permit $_ STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SH RES VILLAGE PLUMBING INSPECTION DEPARTMENT dIN 13 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 s • : w 'ed or not. A copy of approved plans and specifications must )Je kept at building during progress of work. State work to be performed and purpose of building (By Floors)__.. -__ ..... _._ ... --------- - - -._. ------- __ - - -. New Building_ . _ -- Remodeling _ ____ -- Addition.-_- Repairs No. of Stories_ . ... .. .. ...... . . — _ __Dist. Feet of Tank or Drain Field from Well ( (Signed) c,* Date._ Street Capacity Gals. _Size 9(,Soakage Pit Plum g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as :I a ployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup . a nt, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b im 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 perf • ed under this r1 j as are licensed by Miami Shores Village. lum er. 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 insp - n, or faulty materials and /or workmanship. . CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS 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'S POOL CONTR. LIST CHECK Permit No ('") Owner's Name and Address Registered Architect and /or Engin Employing Plumber's Name Location and Legal Description • t. Street and Number where work is to be performed —No Size Septic Tank___ ......... _______--.... ---- - - - - -- -Type of Tank__ Feet of Drain Tile_—.__ Nature of Water Supply: City—Well Amount of Permit $_ STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SH RES VILLAGE PLUMBING INSPECTION DEPARTMENT dIN 13 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 s • : w 'ed or not. A copy of approved plans and specifications must )Je kept at building during progress of work. State work to be performed and purpose of building (By Floors)__.. -__ ..... _._ ... --------- - - -._. ------- __ - - -. New Building_ . _ -- Remodeling _ ____ -- Addition.-_- Repairs No. of Stories_ . ... .. .. ...... . . — _ __Dist. Feet of Tank or Drain Field from Well ( (Signed) c,* Date._ Street Capacity Gals. _Size 9(,Soakage Pit Plum g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as :I a ployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup . a nt, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b im 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 perf • ed under this r1 j as are licensed by Miami Shores Village. lum er. 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 insp - n, or faulty materials and /or workmanship. . BUILDING ELECTRICAL PLUMBING ROOFING Architect Contractor or Builder Legal Description Lot MIAMI SHORES VILLAGE, FLORIDA ❑ DATE. 19 PERMIT 3868 Contractors a ;� License No. 0 ❑ Work to be performed under this Permit Owner of Building CONTRACTOR OR BUILDER Bl. BY AUTHORITY Subdi- vision Address of Value of I Amount of Building Project $ ( 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed. 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. ABBOT PRINT Notary My Comm ** * PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date of 7 74 Job Address Legal Description M '‘'I& SV Ut d1' C 1 -0+ LA-j LC) Owner Lessee / Tenant g4( /0 Master Permit # , r,.S3 er's Address Contracting Co. � 4//;1(1 4 / ' Address Qualifier 00:W ph SS # Phone / -x ' fy �,M 1 2�� XY State # / J / /��� Municipal # ��V�'���l�Competency 4Fh��Gy�.�4��� Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICA PLUMBING,,M$CHANIC 33 /L Square Ft. Estimated Cost(value) authorize the above -named contractor to do the work Tax Folio )) ' 3 2-c t 0 13 - C/o WORK DESCRIPTION 6-/5 .6 (`) 0 27 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 inf•rmation is accurate and that all work will be done in compliance with all applicable laws regul- ing •nstruct and,zoning Furthermore, I otary as to My Commission * * * * * * * * * FEES: PERMIT J©• or) RADON C.C.F. :- NOTARY TOTAL DUE - =0 APPROVED: Fire Other Zoning Buildin: Electrical Mechanical Plumbin: J ' r� Engineerin c v, Phone z57--- 7j77 ROOFING PAVING PENCE SIGN o' — Owner- Builder or Owne Builder :PUBLIC STATE OF FLORIDA CC4 ISSIOA EXP. APR. 1,1994 40NBED THRU GENERAL INS. UND. Pent 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 I Registered Architect and /or Engineer------ -- - - - - - -_ - -_ - -_ _-- -___ Employing Plumber's Name____ / ® AS. ���"__ — Location and Legal Description Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No.__ ' ' 3___ Street 6 5/ &___._ No. Block 333 State work to be performed and purpose of building (By Floors)_____ New Building ______ Remodeling____ Addition_ ( Signed) Date Street Street_i*l -/-2 . — 3_ ' Subdivision Repairs No. of Stories. Type of Tank Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit Capacity Gals Notary Public, State of Florida 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 der 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 notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS S LAVA TORIES INKS SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS a C 64-F - 4 A =CY 13 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST — CHECK Pent 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 I Registered Architect and /or Engineer------ -- - - - - - -_ - -_ - -_ _-- -___ Employing Plumber's Name____ / ® AS. ���"__ — Location and Legal Description Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No.__ ' ' 3___ Street 6 5/ &___._ No. Block 333 State work to be performed and purpose of building (By Floors)_____ New Building ______ Remodeling____ Addition_ ( Signed) Date Street Street_i*l -/-2 . — 3_ ' Subdivision Repairs No. of Stories. Type of Tank Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit Capacity Gals Notary Public, State of Florida 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 der 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 notice for inspection, or faulty materials and /or workmanship. Architect Contractor or Builder Legal Description Address of Building Lot BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building 1 ' MIAMI SHORES VILLAGE, FLORIDA PERMIT IN? 13095 Work to be performed under this Permit t,.'z^. �✓ Bl. Subdi- vision CONTRACTOR OR BUILDER BY Value of Project $ DATE Contractor's License No '1• 5 Amt. of Permit This permit is ranted 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 k. 1�•.;,it - ` 4 !`..+ BY • ti INSPECTOR In consideration of the issuance to me of this permit I agree to pel�to n 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. AUTHORITY Permit No. L. Date. , .... f Application is hereby inade fot 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 Divisior 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 Size Septic Tank Feet of Drain Tile Amount of Permit $ C Nature of Water Supply: City —Well MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. Street -_ __ti Registered Architect and /or Engineer to Plum i '` 1 ; - No P Y�g Plumber's Name. � 1 g P , �_ Em z r-— ` Street ��x - ' - _ — - Location and Le al Description Lot.-_--.__- _--- __y:- _ �i.___t_ Street 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 Type of Tank___ Capacity Gals. Dist. Feet of Tank or Drain Field from Well (Signed) 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 art licensed by Miami Shores Village. r , Size of Soakage Pit (Signed). My Commission Expires Notary Public, State of Florida Plumbing Inspector. 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 appeare 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 far' therein by him stated are true. N t E: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul als and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS INK SLOP SINKS LAUNDRY TUeB R INALS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURE: 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 Permit No. L. Date. , .... f Application is hereby inade fot 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 Divisior 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 Size Septic Tank Feet of Drain Tile Amount of Permit $ C Nature of Water Supply: City —Well MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. Street -_ __ti Registered Architect and /or Engineer to Plum i '` 1 ; - No P Y�g Plumber's Name. � 1 g P , �_ Em z r-— ` Street ��x - ' - _ — - Location and Le al Description Lot.-_--.__- _--- __y:- _ �i.___t_ Street 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 Type of Tank___ Capacity Gals. Dist. Feet of Tank or Drain Field from Well (Signed) 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 art licensed by Miami Shores Village. r , Size of Soakage Pit (Signed). My Commission Expires Notary Public, State of Florida Plumbing Inspector. 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 appeare 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 far' therein by him stated are true. N t E: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul als 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 othe' 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 Divisior 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 Engineer Employing Plumbers Name _ `'_- Street_ Location and Legal Description Lot__._ _— Block________ .! _________— Subdivision Street and Number where work is to be performed —No. State work to be performed and purpose of building (By Floors) ----- '__- _ New Building Remodeling Addition_ Repairs Size Septic Tank Type of Tank_ _ Capacity Cals. 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 $ 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. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ___ ___ (Signed) _ ( Signed)._ Date -- - -- --- - - - - -- Street to a 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 fat - t rein 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 notice for inspection, or faul My Commission Expires Notary Public, State of Florida No. of Stories Plumbing Inspector. Master Plumber. m aterials and /or workmanship. CLOSETS BAT Tue S HOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK I NQ FOUNT' NS ' v, TOTAL FIXTURE! CONTR. L IST / CHECK r y F ,---— ‘ � _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL it/ /' ICY-(!_. n. q - CONTR. LIST CHECK �� (% ni �... 5 Permit No. ____ ... �- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othe' 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 Divisior 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 Engineer Employing Plumbers Name _ `'_- Street_ Location and Legal Description Lot__._ _— Block________ .! _________— Subdivision Street and Number where work is to be performed —No. State work to be performed and purpose of building (By Floors) ----- '__- _ New Building Remodeling Addition_ Repairs Size Septic Tank Type of Tank_ _ Capacity Cals. 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 $ 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. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ___ ___ (Signed) _ ( Signed)._ Date -- - -- --- - - - - -- Street to a 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 fat - t rein 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 notice for inspection, or faul My Commission Expires Notary Public, State of Florida No. of Stories Plumbing Inspector. Master Plumber. m aterials and /or workmanship. ey,