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PLUMBINGPermit No. Size Septic Tank Feet of Drain Tile __ . ____--__ Nature of Water Supply: City —Well. Amount of Permit $ S f 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 co: formity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Mi Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifies or not. A copy of approved plans and specifications must be kept at building during progress of work ti Owner's Name and Address__ LA__1^__- __ ^ -�- -- - No. Street Registered Architect and /or Engineer r Employing Plumber's Name __'. - . -'i et ' 4 '� No. Street Location and Legal Descriptigtf Lot J3lock_ performed—No. t Street and Number where work is to be p __ .�. f , - - State work to be performed and purpose of building (By Floors) si Signed) Signfd)- /- Street New Building ___ Remodeling Addition__ -_ Repairs _Type of Tank _Capacity Gals. Dist. Feet of Tank or Draiu Field from Well ______- ______ Size of Soakage Pit Date.. _. 0 , 7 >/; Subdivision No. of Stories ? o� Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that 1[e understands and accepts his obli ions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Con piled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance fror. all contractors or sub - contractors employed by him in the work to be performed under this pennit; 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. aster Plumber. STATE OF FLORIDA, 1 ss. 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 depo es and says that he is the of the above described construction, that he has carefully read the fort going 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 LAUNI ART TUEi URINALS U CAT BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SPRKLR. SYSTEM SW IM'G POOL SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEE. WELL CONTR. LIST — – - CHECK Permit No. Size Septic Tank Feet of Drain Tile __ . ____--__ Nature of Water Supply: City —Well. Amount of Permit $ S f 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 co: formity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Mi Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifies or not. A copy of approved plans and specifications must be kept at building during progress of work ti Owner's Name and Address__ LA__1^__- __ ^ -�- -- - No. Street Registered Architect and /or Engineer r Employing Plumber's Name __'. - . -'i et ' 4 '� No. Street Location and Legal Descriptigtf Lot J3lock_ performed—No. t Street and Number where work is to be p __ .�. f , - - State work to be performed and purpose of building (By Floors) si Signed) Signfd)- /- Street New Building ___ Remodeling Addition__ -_ Repairs _Type of Tank _Capacity Gals. Dist. Feet of Tank or Draiu Field from Well ______- ______ Size of Soakage Pit Date.. _. 0 , 7 >/; Subdivision No. of Stories ? o� Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that 1[e understands and accepts his obli ions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Con piled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance fror. all contractors or sub - contractors employed by him in the work to be performed under this pennit; 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. aster Plumber. STATE OF FLORIDA, 1 ss. 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 depo es and says that he is the of the above described construction, that he has carefully read the fort going 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.