373 NE 92 St (6)MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
'ar-ei4 T+to.
/ ` Date q 6/'
Application is hereby .nade fos 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 E - -. :E- /_i4_2-- _— ___..____ -_ No. _------ '_ 7.:3 Street-- 9
Registered Architect and /or Engincer.______�.. ____
___ _
Employing Plumber's Name__f..t _l. cFi_I _iU-�_t _e14- 1 c it No.-__.-___._
Location and Legal Description Lot.--__ _---- _ __�______,
Street and Number where work is to be performed —No {
S late work to be performed and purpose of building (By Floors) __ -- - - :1L1 -_� - - -- 1_!? .Ls i
New Building ___ -.__ Remodeling__ -__ Addition_-- _ -.__. Repairs
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contj
performed under this permit; and will post or cause to be posted' for inspection on the site of the
requ.red by the Act The undersigned agrees to employ only such sub- contractors, ork t
licensed by Miami Shores Village.
( Signed)
( Signed )_.
c - -
Street_
___ Block Subdivision_
3 Street
�. _.
My Commission Expires Notary Public, State of Florida
J T
No. of Stories....,
Size Septic Tank. ___ -_— Type of Tank__ Capacity Gals
Feet of Drain Til e ................. -_- -----__Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._____ ___________________Size of Soakage Pit
Plumbing Inspector.
bligations as an employer of labor
ennan Supplement, and has com-
er employed by him in the work to be
such public notice or notices as are
perfo ed under this permit, as are
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. f
Before me, the undersigned authority, a notary public, duly authorized to administ 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.
Cl!atS ?Ti5
BATH
TUSG
SHOW CRS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URIL
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
Cowro.
LIST
C1T.CK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
—•—
Ceaarta.
LIST
—
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
'ar-ei4 T+to.
/ ` Date q 6/'
Application is hereby .nade fos 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 E - -. :E- /_i4_2-- _— ___..____ -_ No. _------ '_ 7.:3 Street-- 9
Registered Architect and /or Engincer.______�.. ____
___ _
Employing Plumber's Name__f..t _l. cFi_I _iU-�_t _e14- 1 c it No.-__.-___._
Location and Legal Description Lot.--__ _---- _ __�______,
Street and Number where work is to be performed —No {
S late work to be performed and purpose of building (By Floors) __ -- - - :1L1 -_� - - -- 1_!? .Ls i
New Building ___ -.__ Remodeling__ -__ Addition_-- _ -.__. Repairs
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contj
performed under this permit; and will post or cause to be posted' for inspection on the site of the
requ.red by the Act The undersigned agrees to employ only such sub- contractors, ork t
licensed by Miami Shores Village.
( Signed)
( Signed )_.
c - -
Street_
___ Block Subdivision_
3 Street
�. _.
My Commission Expires Notary Public, State of Florida
J T
No. of Stories....,
Size Septic Tank. ___ -_— Type of Tank__ Capacity Gals
Feet of Drain Til e ................. -_- -----__Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._____ ___________________Size of Soakage Pit
Plumbing Inspector.
bligations as an employer of labor
ennan Supplement, and has com-
er employed by him in the work to be
such public notice or notices as are
perfo ed under this permit, as are
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. f
Before me, the undersigned authority, a notary public, duly authorized to administ 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.