87 NE 92 St (2)04:LCag.e og Miami. 5ho'e&
xxtempootow
DADE COUNTY, FLORIDA
DIVISION OF PLUM
ING INSPECTION
P-((3
ILDING PERMIT NO. PLUMBING
3—(7_7
PERMIT NO.
TYPE i NUMBER
RGH SET
FEE
BATH TUB
i
Contractor Phone
0 i Neat &Loc% & Septic 7avik Co. 635 -6
BIDET
,
DISHWASHER l
Contractor's Address
1368 Al. (v. 29th Vaee't
DISPOSAL 1
DRINKING FOUNTAIN
Owner's Name Phone
KKiatt
Job Address
87 Al. C. 92vu1 5taee -t
FLOOR DRAIN
k
j
GREASE TRAP
INTERCEPTOR
LAVATORY
Lot Block Subdivision
LAUNDRY TRAY
J
CLOTHES WASHER I
I
Present or Proposed Use of Building
lea
SHOWER I
I
SINK, POT /3 -COMP.
,
- I
1
Old
New
No. of Bedrooms
SINK RESIDENCE !
SINK, SLOP )
Applica ion is hereby made to obtain o permit to do the work and installo-
tions as hereon indicated. I certify that no work or installation has been
effected prior to the issuance of said permit and that all work will be per -
formed to m/ the standards of all laws regulating construction in Dodo
Count / ,
TEMPORARY WATER CLOSET
URINAL
1
WATER CLOSET
INDIRECT WASTES
—1
Signature of Master Plumber or • ner
WATER SUPPLY TO:
—I
AIR CONDITIONING UNIT
FIRE SPRINKLER
HEATER,— NEW INSTALLATION
HEATER - REPLACE
LAWN SPRINKLER - WELL
SWIMMING POOL - WELL
WATER SERVICE
PLUMBING INSPECTIONS
SEWER CONNECTIONS
GROUND
UTILITY — SEWER
ROUGH
1
UTILITY — WATER
TUB & WATER PIPE
SEPTIC TANK
RE LAY
32 '
4.00
SEWER
DRAINFIELD, 4" TILE /RESERVOIR
! SEPTIC TANK
PUMP & ABANDON SEPTIC TANK
SOAKAGE PIT — CU. FT.
WELL
CATCH BASIN
POOL PIPING
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
FINAL PLUMBING
SOLAR WATER HEATER
FIRE STANDPIPE
I I further
myssolf,
qualifiod
Signod
THE OW g(E'S `. FFIDAV/IT:
certify that all work will be done by me personally, for
without any outside help, other than o licensed & duly
contractor as roquired by law.
POOL PIPING
LAWN SPRINKLER SYSTEM
TOTAL FEE
4-00
04:LCag.e og Miami. 5ho'e&
xxtempootow
DADE COUNTY, FLORIDA
DIVISION OF PLUM
ING INSPECTION
P-((3
ILDING PERMIT NO. PLUMBING
3—(7_7
PERMIT NO.
Permit No.
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 at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot_ ( ^^]] _ Block_
__
Street and Number where work is to be performed loit _ Z
Amount of Permit $ '
- -- - -- - — - My Commission Expires
— (Signed)
Date 6
No. a y. -
___-- d_ __ --_ -, Street //
State work to be performed and purpose of building (By Floors)
New Building Remodeling ....... Addition__ -- Repairs
( Signed). h
Z Str eet ____ . 9
Subdivision_ _
Street
No of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well . _Size of Soakage Pit
P1 mbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an - ployer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, 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 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 tlie 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.
Notary Public, State of Florida
oz44 aster PI
STATE OF FLORIDA, I
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
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
SWIM'G
POOL
J Yr / /
I ��q --
ex
cowrR.
LIST
-
CHECK
Permit No.
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 at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot_ ( ^^]] _ Block_
__
Street and Number where work is to be performed loit _ Z
Amount of Permit $ '
- -- - -- - — - My Commission Expires
— (Signed)
Date 6
No. a y. -
___-- d_ __ --_ -, Street //
State work to be performed and purpose of building (By Floors)
New Building Remodeling ....... Addition__ -- Repairs
( Signed). h
Z Str eet ____ . 9
Subdivision_ _
Street
No of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well . _Size of Soakage Pit
P1 mbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an - ployer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, 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 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 tlie 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.
Notary Public, State of Florida
oz44 aster PI
STATE OF FLORIDA, I
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.
Permit No. 49
Owner's Name and Address
Location and Legal Description Lot__
MIAMI SHORES VILLAGE
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 wor
Registered Architect and /or Engineer
rte` 1!%17 Z �
Employing Plumber's Name _— �____ � ��'� � � _
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
D _i y r _____
--- _ -�- -- _____ --
Street_ __ '__ -
Block _ .. _�._
Street and Number where work is to be performed —No q j ____ _�-- - — St t __ r
State work to be performed and purpose of building ( Floors)
_____�
New Building _______ _— ________________ Remodeling Addition Repairs
No __
Street - -r'-
No. of Stories d
Size Septic Tank__ __ ___ — _____________ Type of Tank
Feet of Drain Tile____— _— ____________— _______ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — —____ Size of Soakage Pit
Amount of Permit $___ !
STATE OF FLORIDA,
COUNTY OF DADE. ss.
My Commission Expires
— _Capacity Gals.__________________ —__
v–
-
Plum i y, Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligltfons 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/),) Master Plumber.
-/� /o //
(Signed)
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.
A
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
SINKS
SLOP
SINKS
LAUNDRY
TUBS
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
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No. 49
Owner's Name and Address
Location and Legal Description Lot__
MIAMI SHORES VILLAGE
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 wor
Registered Architect and /or Engineer
rte` 1!%17 Z �
Employing Plumber's Name _— �____ � ��'� � � _
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
D _i y r _____
--- _ -�- -- _____ --
Street_ __ '__ -
Block _ .. _�._
Street and Number where work is to be performed —No q j ____ _�-- - — St t __ r
State work to be performed and purpose of building ( Floors)
_____�
New Building _______ _— ________________ Remodeling Addition Repairs
No __
Street - -r'-
No. of Stories d
Size Septic Tank__ __ ___ — _____________ Type of Tank
Feet of Drain Tile____— _— ____________— _______ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — —____ Size of Soakage Pit
Amount of Permit $___ !
STATE OF FLORIDA,
COUNTY OF DADE. ss.
My Commission Expires
— _Capacity Gals.__________________ —__
v–
-
Plum i y, Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligltfons 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/),) Master Plumber.
-/� /o //
(Signed)
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.
A
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..._.,.e
• MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
b
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 l
� '
Owner's Name and Address f �t ' ' _: _!``` ' _ � = ''� 8 Street.. .X. __
_ __ e f- • P` 61:
Registered Architect and /or Engineer r
Employing Plumbei s Name -, '%A� - *., No Street
+� „ / •_ —� --
Location and Legal Description Lot_
' 2' 21_ Block 2.-- Subd' ision_ d+q��`_
Street and Number where work is to be performed —No q ivl ,_ __"2 Street _ 0
State work to be performed and purpose of building (By Floors)
New Building_________________ Remodeling Addition_____ Repairs__
, k/
Size Septic Tank_ __ — ______ Type of Tank . Capacity
Feet of Drain _______ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $_
_(Signed)
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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
My Commission Expires
(Signed)
No. of Stories L
Plum bt*g Inspector.
�r K IJiaster 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.
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
SINKS
SLOP
SINKS
LAUNDRY
TUBS
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
SWIM'O
POOL
CONTR.
LIST
CHECK
Permit No..._.,.e
• MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
b
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 l
� '
Owner's Name and Address f �t ' ' _: _!``` ' _ � = ''� 8 Street.. .X. __
_ __ e f- • P` 61:
Registered Architect and /or Engineer r
Employing Plumbei s Name -, '%A� - *., No Street
+� „ / •_ —� --
Location and Legal Description Lot_
' 2' 21_ Block 2.-- Subd' ision_ d+q��`_
Street and Number where work is to be performed —No q ivl ,_ __"2 Street _ 0
State work to be performed and purpose of building (By Floors)
New Building_________________ Remodeling Addition_____ Repairs__
, k/
Size Septic Tank_ __ — ______ Type of Tank . Capacity
Feet of Drain _______ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $_
_(Signed)
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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
My Commission Expires
(Signed)
No. of Stories L
Plum bt*g Inspector.
�r K IJiaster 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.
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.
- -^
CLGaETB
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
Corm.
LIST
CHECK
e
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
$W IM'G
POOL
Ceara.
LIR
/
_ .
CHECK
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.
.�J
Owner's Name and Address
Registered Architect and /or Engineer_ _
Employing Plumber's Nam I ( 1i? --I r ° 11> F_;� _ t``�' {h No.
J
Location and Legal Description Lot._.____________ -_ -___ _____ ______ Block
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
Size Septic Tank_ Type of Tank__ Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
c'� o
Amount of Permit $ --_ - -_ (Signed)___
Nature of Water Supply: City — Well.__
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 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.
�- - -_ - My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed) _
7 0 Street__
Subdivision
Street
Repairs No. of Stories.
Street 2 '
Notary Public, State of Florida
MasteLPtumber.
STATE OF FLORIDA, 1
COUNTY OF DADE. 1
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.
9
.._—
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUae
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT NS
SERvICP.
--
TOTAL
FIXTUREi
CONTR.
LIST
CHECK
HA
r3S
1 •
_
SEPTIC
TANK
SEWER
CONN
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WILL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHECK
/�
/0 0
Permit No. ..__/ C6
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address. 4 Ce HIP A r No P?
Registered Architect and /or Engineer _ - -_ -_ --- - -_ - -- _ -_- - _ - -_ -_-
Employing Plumber's Name . 6 "
®� - `� l� 6 ‘f _ -- No ___ br-J G Street (.4) 7
Location and Legal Description Lot--__ Block__.! _._ Subdivision
Street and Number where work is to be performed —No — _- i-__-- _____. ___ Street Ai 6 f' Y
State work to be performed and purpose of building (By oors )
New Building__ -. _. Remodeling Addition Repairs
Size Septic Tank Type of Tank___ Capacity Gals.
Amount of Permit $
(Signed)
(signed)_
Date. 3 s
Street 4 ? ," 4 %;9 1 *
No. of Stories
Feet of Dr Tile Dist. Feet of Tank or Drain Field from Well .............. __._ ... __ _. -..
Nature f Water upply: City —Well / A V 0 --. 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 5966, Compiled General Laws of Florida Permanent Supplement, and ,n-
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work so 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 an
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, �.
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally .Ippeare
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 tae
therein by him 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 hail
materials and /or workmanship.