812 NE 92 St (10)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
struhture 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 No- - - - - -- - -- - - - - - -- Street
Registered Architect and /or Engineer
Plumber's Name No.____ -_. Street
Location and Legal Description Lot Block Subdivision
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 _ .. Repairs No. of Stories
CONTR.
LIST
CHECK
CONTR.
LIST
CHECK
CLOSETS
SEPTIC
TANK
BATH
Tues
SEWER
CONN.
SHOWERS
DRAIN
FIELD
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $ - ( Signed)
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 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.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
ss.
LAVA-
TORIES
SOAKAGE
PIT
Type of Tank '
Dist. Feet of Tank or Drain Field from Well____
_ Size of Soakage Pit
Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
SINKS
SOLAR
HEATER
DEEP
WELL
GREASE
TRAP
SLOP
SINKS
LAUNDRY
TUBS
URINALS
( Signed)
SPRKLR. SWIM 'G
SYSTEM POOL
CATCH
BASIN
FLOOR DRINKING
DRAIN FOUNT'NS
Capacity Gals.
Notary Public, State of Florida
Master Plumber.
TOTAL
FIXTURES
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: 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.