580 NE 92 St (10)Perm. No ....v "' 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.•.Thb application L 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 Stobs Brothers Construction No 580 Street N.E. 92 ST.
Registered Architect and /or Engineer Brooks American Sprinkler Co.
E l.�j ._ .. Na.? 5�..- ......�. ...... s ties I`?.W. 79 SL . .... •
�tion Lot_ ( t� 2 Blo c 41 k !'� i SubdivWon. ` 1/ a sr__
Street and Number where work is to be performed —No 580 .. -----------
_....._.
State work to be performed and purpose of budding (By Floors)_ L Irrigation System.
New Building____ _ _.._. Remodeling_____.__... —_.__ Addition...--- __...__ Repairs No. of Stories
Size Septic Tank_-_ _Type of Tank—__.
Feet of Drain Tile. __ -Dist. Feet of Tank or Drain Field from Well ..
Nature of Water Supply: City —WeIL CCty Size of Soakage Pit.
Amount of Permit tt ` ° (Signed)_ -- \ -
(Signed)
p 24 z. 1989
Capacity Gals
CONTRACTOR LICENSE #1418
Pmb ... pc ....
Plumb Ins tor. .._
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 Pennanent Supplement, and lids com-
piled with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wor:• to be
performed under this permit; and will post or cause to be posted' for inspection oa the site of the k such public notice or notices as an
required by the Act. The undersigned agrees to employ only such sub - contractors, on work Abe performed under this permit, Ks are
licensed by Miami Shores Village.
�,"
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. t
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
VANN ET,T,IOTT
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he Is the QI ......._.......
of the above ��pppp��ctl' .that he bu carefully read till' re appli • , , , and that he did sign the same, and that all facts
therein by him at Ibdlte s ore of Fi he
��
Ny Commission Expires day 13, 1992
Bonded 11,u . • 1-, -. , 1 .,,, . //� 4. / ....e, � :
My Commission Expires / otary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made whim snob read* to snade.esos sery by hnproper notice for inspection, or hefty
materials and/or workmanship.
CLOSETS
BATH
Tu••
..
S
TORIES
SINKS
SLOP
SINK•
LAUNDRY
TUBS
URINAL./
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUMT•N•
I
T
/IItt URe
CONTR.
LIST
CHECK
—
!i[eTIC
TANK
SEWER
CONN.
DRAIN
FIEIO
SO
PIT
G
TRAP
SOLAR
H [ATIN
DEar
WILL.
1 .
SYSTEM
8WIN'O
POOL
CONTII.
LIST
CHECK
X
_
Perm. No ....v "' 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.•.Thb application L 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 Stobs Brothers Construction No 580 Street N.E. 92 ST.
Registered Architect and /or Engineer Brooks American Sprinkler Co.
E l.�j ._ .. Na.? 5�..- ......�. ...... s ties I`?.W. 79 SL . .... •
�tion Lot_ ( t� 2 Blo c 41 k !'� i SubdivWon. ` 1/ a sr__
Street and Number where work is to be performed —No 580 .. -----------
_....._.
State work to be performed and purpose of budding (By Floors)_ L Irrigation System.
New Building____ _ _.._. Remodeling_____.__... —_.__ Addition...--- __...__ Repairs No. of Stories
Size Septic Tank_-_ _Type of Tank—__.
Feet of Drain Tile. __ -Dist. Feet of Tank or Drain Field from Well ..
Nature of Water Supply: City —WeIL CCty Size of Soakage Pit.
Amount of Permit tt ` ° (Signed)_ -- \ -
(Signed)
p 24 z. 1989
Capacity Gals
CONTRACTOR LICENSE #1418
Pmb ... pc ....
Plumb Ins tor. .._
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 Pennanent Supplement, and lids com-
piled with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wor:• to be
performed under this permit; and will post or cause to be posted' for inspection oa the site of the k such public notice or notices as an
required by the Act. The undersigned agrees to employ only such sub - contractors, on work Abe performed under this permit, Ks are
licensed by Miami Shores Village.
�,"
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. t
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
VANN ET,T,IOTT
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he Is the QI ......._.......
of the above ��pppp��ctl' .that he bu carefully read till' re appli • , , , and that he did sign the same, and that all facts
therein by him at Ibdlte s ore of Fi he
��
Ny Commission Expires day 13, 1992
Bonded 11,u . • 1-, -. , 1 .,,, . //� 4. / ....e, � :
My Commission Expires / otary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made whim snob read* to snade.esos sery by hnproper notice for inspection, or hefty
materials and/or workmanship.
Permit No
5
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 et
building during progress of work.
Owner's Name and Address v l --. C " a 5 C., r\.\ T' No 5 Street. �
...E.=
Registered Arrchitte r and /or Engineer
/ /
ro $N � TP�.1 -S - C3 N and'Legal I�escti Lot ' Bkr 9 ri Subdivision (Cl1.Q
efy-yee
Date //— /C
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By
New Building- - - ---_ — _.._..- .... - - -_.. Remodeling__ V __.__ Addition..._......_..- _..... Repairs No. of Stories
Street
—
Amount of Permit 8 7 ' 6®
f; (Signed)_ ^ IX •\( %0
Size Septic Tank_ Type of Tank
Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well..._.__..___. —_._.
Nature of Water Supply: City —WeIL Size of Soakage Pit
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 5989, Compiled General Laws of Florida Permanent Supplement, and IIr•1 cnm-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the k such public notice or notices as arr
required by the Act. The undersigned agrees to employ only such sub -eontr •. k .. and this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, l
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 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 81.00 will be made whoa wrab Aisp.olfas is Bsade.eammary by Improper aotioe few brpect1oe, or faulty
materials and /er workmanship.
CLosrr.
BATH
TOSS
SHOW[RI
LAVA
TOR [
SINK•
SLOP
SINKS
LAUNDR
Tula
URINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
IOUNT•N[
TOTAL
/17TUR[[
-
Cowrie.
LIST
°��
_ 1
/
CHICK
/ l
SEPTIC
TANK
SEWER
Comm.
DRAIN
FI[LD
SOAKAO[
PIT
G
TRAP
SOLAR
HEATER
Gaul
WILL
B
9
BWIN'O
POOL
COHTR.
LIST
CHECK
Permit No
5
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 et
building during progress of work.
Owner's Name and Address v l --. C " a 5 C., r\.\ T' No 5 Street. �
...E.=
Registered Arrchitte r and /or Engineer
/ /
ro $N � TP�.1 -S - C3 N and'Legal I�escti Lot ' Bkr 9 ri Subdivision (Cl1.Q
efy-yee
Date //— /C
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By
New Building- - - ---_ — _.._..- .... - - -_.. Remodeling__ V __.__ Addition..._......_..- _..... Repairs No. of Stories
Street
—
Amount of Permit 8 7 ' 6®
f; (Signed)_ ^ IX •\( %0
Size Septic Tank_ Type of Tank
Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well..._.__..___. —_._.
Nature of Water Supply: City —WeIL Size of Soakage Pit
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 5989, Compiled General Laws of Florida Permanent Supplement, and IIr•1 cnm-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the k such public notice or notices as arr
required by the Act. The undersigned agrees to employ only such sub -eontr •. k .. and this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, l
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 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 81.00 will be made whoa wrab Aisp.olfas is Bsade.eammary by Improper aotioe few brpect1oe, or faulty
materials and /er workmanship.
APPLICATION FOR PLUMBING ° ! :tAt MIT
Permit No _ 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. //
Owna?'a Name and Address J0 ti./ 5
Registered Architect and /or Engineer_._____. --
Employing Plumber's Name /ri e etR49ee 84 ye ,�1 e8 V
Location and Legal Description Lot--._-.-_____ Blcrk _— ...— ._________ Subdivision-- • o e.
Street and Number where work is to be performed —No F'" Gv e 9 Street
State work to be performed and purpose of building (By Floors ) __ ._ - __
Naw Building ___�, Remodeling ______ Addition
Size Septic Tank
Feet of Drain Tile._ ...Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well.
----------------------------------
Amount of Permit $
S `ATE OF FLORIDA, I es.
uNTY OF DADE.
My Commission Expires
MIAMI SHOR S VILLAGE
PLUMBING INSPECT! N DJPARTMENT
No._____._______.___ -._ Street
Type of Tank Capacity Gals
Size of Soakage Pit
(Signed) _
Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his • .ligations as an employer of labor
under tine Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor 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 uch public notice or notices as are
reggired 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. --3
Master Plumber.
Notary Public, State of Florida
F (fore 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 Fhc above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
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
SHOWER!
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' N5
TOTAL
FIXTURES
CONTR.
LIFT
�y
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SWIM'G
POOL
WM TVA
wade
CONTR.
LIST
/
CHECK
APPLICATION FOR PLUMBING ° ! :tAt MIT
Permit No _ 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. //
Owna?'a Name and Address J0 ti./ 5
Registered Architect and /or Engineer_._____. --
Employing Plumber's Name /ri e etR49ee 84 ye ,�1 e8 V
Location and Legal Description Lot--._-.-_____ Blcrk _— ...— ._________ Subdivision-- • o e.
Street and Number where work is to be performed —No F'" Gv e 9 Street
State work to be performed and purpose of building (By Floors ) __ ._ - __
Naw Building ___�, Remodeling ______ Addition
Size Septic Tank
Feet of Drain Tile._ ...Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well.
----------------------------------
Amount of Permit $
S `ATE OF FLORIDA, I es.
uNTY OF DADE.
My Commission Expires
MIAMI SHOR S VILLAGE
PLUMBING INSPECT! N DJPARTMENT
No._____._______.___ -._ Street
Type of Tank Capacity Gals
Size of Soakage Pit
(Signed) _
Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his • .ligations as an employer of labor
under tine Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor 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 uch public notice or notices as are
reggired 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. --3
Master Plumber.
Notary Public, State of Florida
F (fore 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 Fhc above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
o PERMIT N9 336 Contractor's
o License No.
0
DATE 19 '
❑ Work to be performed under this Permit
Architect _^
or Contractor
Builder •
or Builder 1. -
B1
Subdi-
vision
Value of II Amount of
Project $ 11 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. 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-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
ABBOT PRINT
A', _, _ . / fQ 6
Date. - - - -
Ap .dication is hereby i»wk for the approval of the detailed statement of the plans and specifications herewi 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. a. - $ 9,1 „J - E: C 4
Owacrs Nam and Address 6> � __ ?'c_ L - i a- No.____ Street
* A - Y . S ,:1.
33`
Registered Architect and /or En i - --- _------------- .-- ______ -_
Employing Plumber's Name_ -_ D r �� --- `�—� t -_ -_ - -- No. __ ‘c2 Street__A / G
Location and Legal Description Lot.-__--___ ___ __________ — Block a Subdivision .......
____
Sao a - Sr
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.
Type of Tank_
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well._______ —CZ_` 4
Size Septic Tank
Feet of Drain Tile_-__
Amount of Permit $_
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Repairs No. of Stories.
Capacity Gals
_Size of Soakage Pit
(Signed)
PIun bang Inspector. -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su element, and bus 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 u3ader 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
r.: ..7:1%./ by tlie Act. The undersigned agrees to employ only such sub - contractors, on w � k to be performe • under this permit, as are
lic sei kr Miami Shores Village.
( Signed).
Notary Public, State of Florida
Master Plu .' . er.
STATE OF FLORIDA, as.
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 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.
CL68ETB
BATH
TUBS
SHOWER!
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
URL
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
Ltl,T
CHECK
--'-'
- --
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM' G
POOL
CONTR.
LIST
-
CHECK
A', _, _ . / fQ 6
Date. - - - -
Ap .dication is hereby i»wk for the approval of the detailed statement of the plans and specifications herewi 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. a. - $ 9,1 „J - E: C 4
Owacrs Nam and Address 6> � __ ?'c_ L - i a- No.____ Street
* A - Y . S ,:1.
33`
Registered Architect and /or En i - --- _------------- .-- ______ -_
Employing Plumber's Name_ -_ D r �� --- `�—� t -_ -_ - -- No. __ ‘c2 Street__A / G
Location and Legal Description Lot.-__--___ ___ __________ — Block a Subdivision .......
____
Sao a - Sr
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.
Type of Tank_
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well._______ —CZ_` 4
Size Septic Tank
Feet of Drain Tile_-__
Amount of Permit $_
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Repairs No. of Stories.
Capacity Gals
_Size of Soakage Pit
(Signed)
PIun bang Inspector. -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su element, and bus 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 u3ader 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
r.: ..7:1%./ by tlie Act. The undersigned agrees to employ only such sub - contractors, on w � k to be performe • under this permit, as are
lic sei kr Miami Shores Village.
( Signed).
Notary Public, State of Florida
Master Plu .' . er.
STATE OF FLORIDA, as.
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 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.