80 NE 92 St (2)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Contractor
or Builder " `
Legal Lot
Description
Address of
Building
Owner of
Building r, 0 o
Architect
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 7434
Work to be performed under this Permit :":
N , / rl -`y
Signed• e " -
s 7 4.
Value of
Project $
DATF
Contractor's
License No. Z
//O
BY:
BY AUTHORITY
195
Subdi-
vision
Amount of i - 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 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 ravoked 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.
INSPECTOR
/7
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 specificatio 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.
BUILDING ❑
ELECTRICAL El �1, DATE 195 ;
PLUMBING 4 PERMIT �° 7801 Contractor's
License No
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
BI.
Subdi-
vision
Sq. Ft
Value of
Project $
Amt. of ,.
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 :he 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 r:voked 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. t
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 a.:id 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.
y „ .-,.�
•
BY AUTHORITY
Permit No / LL—
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, ',bother herein specified or not. A Dopy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address E' • �' L 4V' t. No .L) (� Street_.
Registered Architect and /or E gineer _
Einploying Plumber's Name N92TN D eeT'ic NK_
Location and Legal Description Lot- Blots Subdivision__
Street and Number where work is to be performed —No ASU /t.)6 Street 22. . ._
State work to be performed and purpose of building (By Flaosi)__._._
New Building.____._ _ ---- ..........._.. Remodeling — -- Addition -- • -. - -_ --- _ - -. -- Repairs No. of Stories........ .
Size Septic Tank__
Feet of Drain Tile 07-5
Nature of Water Supply: City—Well.
Amount of Permit $
IAM5 SHORES VILL G
PLUMBING INSPECTION DEPARTMENT
APPLICATBON FOR PLUMBING PERMIT
Type of Trank
. Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
Plumbing Inspec
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 Worinnen'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 are
licensed by Miami Shores Village.
(Signed)
Date. •Cta. 7
_Capacity Gals._.-.__._.__._______
/
Muter Plwnber.
STATE OF FLORIDA, }
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 be 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. ,
M Commissiou Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be spade Mee n swab saisspeetime is ureda•meesmsary by improper settee for inspection, er faulty
materials and /or workmanship.
CLOOSTG
BATH
TUDO
SHOWERS
LAVA.
TORTE•
(><INK6
SLOP
@Inns
LAUNDRY
TUG •
URINAL.
I
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE•
s
CONTa.
LIST
CHECK
_
,.
SEPTIC
TANK
BQWER
CONN.
DRAIN
F IQLD
SOAKAGE
PIT
GREA•I
TRAP
SOLAR
HIUTER
DEEP
WELL
SPRKLN.
SYSTEM
eWIM
POOL
CONTR.
LIST
,-
CHECK
Permit No / LL—
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, ',bother herein specified or not. A Dopy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address E' • �' L 4V' t. No .L) (� Street_.
Registered Architect and /or E gineer _
Einploying Plumber's Name N92TN D eeT'ic NK_
Location and Legal Description Lot- Blots Subdivision__
Street and Number where work is to be performed —No ASU /t.)6 Street 22. . ._
State work to be performed and purpose of building (By Flaosi)__._._
New Building.____._ _ ---- ..........._.. Remodeling — -- Addition -- • -. - -_ --- _ - -. -- Repairs No. of Stories........ .
Size Septic Tank__
Feet of Drain Tile 07-5
Nature of Water Supply: City—Well.
Amount of Permit $
IAM5 SHORES VILL G
PLUMBING INSPECTION DEPARTMENT
APPLICATBON FOR PLUMBING PERMIT
Type of Trank
. Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
Plumbing Inspec
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 Worinnen'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 are
licensed by Miami Shores Village.
(Signed)
Date. •Cta. 7
_Capacity Gals._.-.__._.__._______
/
Muter Plwnber.
STATE OF FLORIDA, }
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 be 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. ,
M Commissiou Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be spade Mee n swab saisspeetime is ureda•meesmsary by improper settee for inspection, er faulty
materials and /or workmanship.
p?
Permit No r ((p
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN '
APPLICATION FOR PLUMBING .' 4;,rl IT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the b ilding 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� No � 1 � t/ � Street_._?04 „if
Registered Architect and /or Engineer 11
Employing Plumber's Name p S. _ _ 4_ _______ No.______ 7 - 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 Gals.
Feet of Drain Tile _____._________Dist. Feet of / Tank o ain Field from Well
Nature of Water Supply: City -Well P i �v Size of Soaka:e Pit
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Street
-__ - - -- - - -- - - _ (Signed) - - _______
Lv
1'
No. of Stories .. . ..
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his46.ligations 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.
aster Plumber.
Lefore me, the undersigned authority, a notary public, duly authorized to administer and take acknowledgments, . `rsonally :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 hin, 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
TUBE
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tulsa
B
I NAS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•Ns
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW 11.4•G
POOL
CONTR.
LIST
CHECK
p?
Permit No r ((p
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN '
APPLICATION FOR PLUMBING .' 4;,rl IT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the b ilding 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� No � 1 � t/ � Street_._?04 „if
Registered Architect and /or Engineer 11
Employing Plumber's Name p S. _ _ 4_ _______ No.______ 7 - 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 Gals.
Feet of Drain Tile _____._________Dist. Feet of / Tank o ain Field from Well
Nature of Water Supply: City -Well P i �v Size of Soaka:e Pit
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Street
-__ - - -- - - -- - - _ (Signed) - - _______
Lv
1'
No. of Stories .. . ..
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his46.ligations 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.
aster Plumber.
Lefore me, the undersigned authority, a notary public, duly authorized to administer and take acknowledgments, . `rsonally :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 hin, 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.
"
Permit No. 7 �
Size Septic Tank
Amount of 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 at
building during progress of work.
Owner's Name and Address.
Registered Architect and /or Engineer ..... _____
____
Employing Plumber's Name :5.q? ` ' — No._____..__ Street___
Location and Legal DescriptioVLot_______—._ — —�_— Block_ / Subdivision � .
Street and Number where work is to be performed— No._____6 01...6. q. X _ — g Street
State work to be performed and purpose of building (By Floors) _ ______________
N evi Buildin ___.- Remodeling Addition..___.__._ Repairs
Type of Tank Capacity Gals. -
Feet of Drain Tile.__ ...... ____. _ ___ ... ________Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup Well. -_------_•-------------- ---- -... -- ..... - _______ . Size of Soakage Pit
STATE OF FLORIDA,
COUNTY OF DADE.
es.
IAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
-- -___ -- (Signed)
No.___ Street
(Signed)
Date / - ,
No of Stories. ............
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts / is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida "ennanent Supplement, and :las 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.
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.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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
INK
S6
SLOP
SINKS
LAUNDRY
Tuss
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CONTR.
LIST
/
0
/
/
CHECK
_
- - --
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
/
J
CONTR.
LIST
/
e
1
1
—
_ - -- —
CHECK
"
Permit No. 7 �
Size Septic Tank
Amount of 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 at
building during progress of work.
Owner's Name and Address.
Registered Architect and /or Engineer ..... _____
____
Employing Plumber's Name :5.q? ` ' — No._____..__ Street___
Location and Legal DescriptioVLot_______—._ — —�_— Block_ / Subdivision � .
Street and Number where work is to be performed— No._____6 01...6. q. X _ — g Street
State work to be performed and purpose of building (By Floors) _ ______________
N evi Buildin ___.- Remodeling Addition..___.__._ Repairs
Type of Tank Capacity Gals. -
Feet of Drain Tile.__ ...... ____. _ ___ ... ________Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup Well. -_------_•-------------- ---- -... -- ..... - _______ . Size of Soakage Pit
STATE OF FLORIDA,
COUNTY OF DADE.
es.
IAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
-- -___ -- (Signed)
No.___ Street
(Signed)
Date / - ,
No of Stories. ............
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts / is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida "ennanent Supplement, and :las 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.
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.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
4.7 i 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.
Owner's Name and Address.Ja '--
Registered Architect and /or Engineer_ vz
Employing Plumber's NameL
New Building Remodeling_-
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
- - -- - -- My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEI \ - '
APPLICATION FOR PLUMBING
Location and Legal Description Lot Block__ _ ___ _ _ Subdivision
Street and Number where work is to be performed -No a � _o _9� e�>�5G?S.�___ Street
State work to be performed and purpose of building (By Floors)
No Street
Nature of Water Supply: City -Well. Size of Soakage Pit
Street
Addition Repairs No. of Stories.
Capacity Gals._
'st. Feet of Tank or Drain Field from Well
(Signed)
` bing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio .: s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup • lement, and I lan 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
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed
licensed by Miami Shores Village.
(Signed )Z2/ y 1,
Notary Public, State of Florida
under this permit, as
tom.
are
are
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 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 inspections, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
S
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
Comm.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
•
CONTR.
LIST
—
_
CHECK
4.7 i 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.
Owner's Name and Address.Ja '--
Registered Architect and /or Engineer_ vz
Employing Plumber's NameL
New Building Remodeling_-
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
- - -- - -- My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEI \ - '
APPLICATION FOR PLUMBING
Location and Legal Description Lot Block__ _ ___ _ _ Subdivision
Street and Number where work is to be performed -No a � _o _9� e�>�5G?S.�___ Street
State work to be performed and purpose of building (By Floors)
No Street
Nature of Water Supply: City -Well. Size of Soakage Pit
Street
Addition Repairs No. of Stories.
Capacity Gals._
'st. Feet of Tank or Drain Field from Well
(Signed)
` bing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio .: s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup • lement, and I lan 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
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed
licensed by Miami Shores Village.
(Signed )Z2/ y 1,
Notary Public, State of Florida
under this permit, as
tom.
are
are
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 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 inspections, or faulty
materials and /or workmanship.