PLUMBINGMIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION F R PLUMBING PERMIT
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.
I
Owner's Name and Address _- - - i -- ----- _. - -. - -- _ - •---- -_ - -.- No. Street_
Registered Architect and /or Engineer___ _
Employing Plumber's Name _:_4/
_ __ __ No._ Street,_ —..
Location and Legal Description Lot_-___�i BI Subdivision
Street and Number where work is to be performed —No fa 9 Streak
State work to be performed and purpose of building (By Floors)
New Building Remodeling - Addition Repairs No. of Stories. _ .._._
1
Size Septic Tank_
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $-
STATE OF FLORIDA,
as.
COUNTY OF DADE.
(Signed)_
(Signed).
My Commission Expires Notary Public, State of Florida
_Type of Tank__ Capacity Gals
___Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit 1 1
aster Plumber.
mbing . pector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatian employer If labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent - .plement, and Ilai 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.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly swoni, 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 insp " m 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
I
TOTAL
TOTAL
CONTR.
LIST
CNZCK
I I
---
I
- --
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION F R PLUMBING PERMIT
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.
I
Owner's Name and Address _- - - i -- ----- _. - -. - -- _ - •---- -_ - -.- No. Street_
Registered Architect and /or Engineer___ _
Employing Plumber's Name _:_4/
_ __ __ No._ Street,_ —..
Location and Legal Description Lot_-___�i BI Subdivision
Street and Number where work is to be performed —No fa 9 Streak
State work to be performed and purpose of building (By Floors)
New Building Remodeling - Addition Repairs No. of Stories. _ .._._
1
Size Septic Tank_
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $-
STATE OF FLORIDA,
as.
COUNTY OF DADE.
(Signed)_
(Signed).
My Commission Expires Notary Public, State of Florida
_Type of Tank__ Capacity Gals
___Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit 1 1
aster Plumber.
mbing . pector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatian employer If labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent - .plement, and Ilai 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.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly swoni, 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 insp " m or faulty
materials and /or workmanship.