965 NE 92 St (4)— ^_
CLCtOS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
UR
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TURE6
LILT
CialECIL
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CiDFb i3.
- -l—
CMECK
?,;.edit No , 2Cp o
Application is hereby mad. for he 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 ��L :� at� =r-- No. Street
fde3kstered Architect and /or Engine
Employing Plumber's Name
Location and Legal Description Lot---____ _______ _ Blot
Stra and Number where work is to be performed —No � ? .4I .__ Street-
Ea:,tc walk to be performed and purpose of building (By Floors) __ ------ .-------------- ___. -_._
New Building __- Remodeling
Amount of Permit
STATE OF FLORIDA,
COUNTY OF DADE. j es.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Street--_-_ - ..
Subdivision
3 //-/
Addition ________.___________..._ Repairs No. of Stories
Size Septic Tank__ C — - - -- --Type of Tank__ Capacity Gals
Feet of Drain Tile__.�� E Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well - -__ - - -- ---- •--- -�__ --
Size of Soakage Pit
( Signed) _
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and a y'..' his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of F ...: a Pennanent Supplement, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
perfon3d 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
rez tared 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 Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to aye 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
theraln 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
matriAals and /or workmanship.
;UILDING
LECTRICAL
'LUMBING
Jwner of
wilding
Architect
Contractor
nr Builder C/
.egal
) escription
Lot
v
MIAMI SHORES VILLAGE, FLORIDA
?l
DATE >� 19
'PERMIT N?' 4114 Contractor's j ..
License No.
f '
Work to be performed under this Permit
Bl.
Address of e„,,... alue of 1 Amt. of 0
iuilding r ; 4 _ , Project Permit
This permit is granted to the con tractor or builder named above to construct the building or to install the equipment or devic described in the appli-
:ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
,lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be re}ybked
=t 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
lermit is granted is the understanding that the contractor or builder named above assumes the res onsibili for a thorough knowledge of the ordinances and
egulations pertaining to the work covered hereby whether shown on the plans or drawings or in e stat �,' is or specifications and that he assumes respon-
ONTRACTOR OR BU
Subdi-
vision
;ibility for work done by his agents, servants or employees. /
Signed • to s" INSPECT
•
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinan s and regulations
Iertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Mimi Shores Village.
in accepting this permit I assurie regponsibility for all work done by either myself, my agent, servant or employee.
BY AUTHORITY
By