PLUMBING• APPLICATION FOR PLUMBING PERMIT
Permit No. __
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub4 itted 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__ rt. t �� No. _1 U 3 G 1� <$treet 7
Registered Architect and /or En ' er
N:
Employing Plumber's une t -- - '' t- 2- Cn Street t r � 1'. tt/k'1
- ti -
Location and Legal Description Lot Block Subdin
�, ( /U c, '
Street and Number where work is to be performed —No ( r - Street i
It )A L ." q
� --tea 44
Remodeling
New Building g Addition Repairs No. of Stories.__
State work to be performed and purpose of building (By Floors) ___E_
Size Septic Tank
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Date
l'
y
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 .__ ___
My Commission Expires
( Signed)
(Signed)
Cj ( i iV �i
.. C Q
Plumbing Inspecto
The undersigned applic for this building permit does hereby certify that he understadds and accepts his obligations as an employer of labor
under the Florida Wor v -n's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplemeeit, and has com-
plied with the prow' '.ns thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under tfiis 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.
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 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
• APPLICATION FOR PLUMBING PERMIT
Permit No. __
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub4 itted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. _
Owner's Name and Address ' l__ rt. t �� No. _1 U 3 G 1� <$treet 7
Registered Architect and /or En ' er
N:
Employing Plumber's une t -- - '' t- 2- Cn Street t r � 1'. tt/k'1
- ti -
Location and Legal Description Lot Block Subdin
�, ( /U c, '
Street and Number where work is to be performed —No ( r - Street i
It )A L ." q
� --tea 44
Remodeling
New Building g Addition Repairs No. of Stories.__
State work to be performed and purpose of building (By Floors) ___E_
Size Septic Tank
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Date
l'
y
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 .__ ___
My Commission Expires
( Signed)
(Signed)
Cj ( i iV �i
.. C Q
Plumbing Inspecto
The undersigned applic for this building permit does hereby certify that he understadds and accepts his obligations as an employer of labor
under the Florida Wor v -n's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplemeeit, and has com-
plied with the prow' '.ns thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under tfiis 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.
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 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.
- - -^
CLOaRa
BATH
PUS•
aNOWLRL
LAVA.
TORIES
S
SLOP
SINK•
LAUNDRY
Tun•
U RINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N•
TOTAL
FIXTURES
CONTS.
LIST
CHECK
SEPTIC
TANK
SLWLR
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
MEATIER
DLI
WILL
arm aLR
8
SWIN•0
POOL
I
I !
Comm.
LIST
CHICK
I
Permit No 11<b �" 2
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.
Owners Name and Address
Registered Architect and /or Engineer
Employing Plumber's Natu J i b , l � /i �v,� N a,..... �� Z ?- ..m Itr ... `-" � .- v - •
Location and Legal Desctlption / Iat Bloc _ �Subdivision_________ ._._ •
Street and Number where work is to be performed —No S Str ..1 y p � k._. A.
5 .. .._
State work to be performed and purpose of building (By Floors) 1- e . i . I � i . 0 0 F 7 - . . . • I A 1 , 1/4 4 - . - - ie.
New Building.. -_.__ - .. -.. Remodeling ___ Addition. ..___..... .._.... Repairs /V No. of Stories......
Size Septic Tank__ Type of T■n
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 $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
y No J 03 CJ' Street.. Ai.- 96
/ 6 7 .3
(Signed)_. f ..
Capacity Gals•-- - - - - -- _ - - -- - - - --
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 libel com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors p1. ed by him in the work to he
performed under this permit; and will post or auae to be posted for inspection on the site e work
blic notice or notices as err
required by the Act. The undersigned agrees to employ only such sub - contractors, on
licensed by Miami Shares Village.
are
STATE OF FLORIDA. }
u.
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.
My Commission Expires Notary Public, State oI Florida
NOTE: A re-inspection fee oI $1.00 will be made wham such miasma= le snede.neossemy by improper notice for Inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor / f
or Buie! t� �`C ,
Legal Lot Bl. ;!
Description
r
Address of
Building f°`'
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 revoked 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 show n the wings or in the statements or s cifieations and
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder ia;Eompliance with all ordinances and regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village., J 'accepting this permit I assume responsibility for all work done by either m ,'; my a ent, servant or employee.
that he assumes responsibility for work done by his agents, servants or employees.
Signed-
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
RM IT N? 1061 Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project
Amt. of
Permit
By
...•'fir i
6
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE 1 ^ ' '^i 11 95
ELECTRICAL ❑ PERMIT N? 12121
PLUMBING
ROOFING (1 Work to be performed under this Permit
..
Owner of ..i/
Building
CONTRACTOR OR BUILDER
Signed:
INSPECTOR
Contractor's
License No
Architect
Contractor
CC.-- or Builder `,J ! ,J
Legal Lot I gl. Subdi-
Description vision
Address of - `' 1 Value of
Building ) ; � q °�_, , , J r Project $
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 revoked 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.
-BY
Amt. of
Permit $
In consideration of the issuance to me of this permit I agree to per the work covered hereunder in compliance with all ordinances and 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 asine responsibility for all work done by either, myself, my agent, servant or employee.
4
f
L PERMIT A N? 936
PLUMBING
.
..
Owner of Building_____ _ __�.�.ef'� ' �`��`
NAME
Architect and /or Engineer ____ _ . -- __
J t { / fMAME 14. , ADDRESS
Contractor or Builde ' 4
! NAME A9DRESS LICENSE NO.
` 'i
Proposed Location _�,, - """'
__ . _ ` *' i ' t om'` 1 >-� r '"''"
��
LOT SL CK SUS-DIN/MITI NO. STREET
Th permit is issued to_ / (_ -� t a s ` _4e # (" Tp _ -1 - ":. s • -1 �,. _¢g/
the building above described. as per application. Plans and Sp fications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted. and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances or rules and regulations. or upon any change in the plans and specifications unautllprized by the building inspector.
emse
AMOUNT •
RECD. PAYMENT ACCT. DEPT.
MIAMI SHORES VILLAE
BUIL m ING INSPECTION DEPARTMENT
c ti. r
ADDRESS LICENSE NO.
INSPECTOR
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
plans and specifications thereof heretofore by me submitted; and in compliance with all provisions of all building laws of the State of Florida, all the
building ord ' ces and zoning laws of Miami Shores Village a and all rules and regulations of the � bt ldin partment orMisphi Village.
Dated S._ - ."--.•P . 19_4'�� � f _ 02-, :k--.1 6 `'+ r= `
SEAL)
: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection he of ;1.00 will be made when such re.inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
MIAMI SHORES VILLAGE, FLORIDA
BUILDING J DATE
ELECTRICAL -PERMIT N? 1209 Contractor's
PLUMBING License No. /
,..P i / -.
Work to be performed under this Permit. c p. / 1' ,. i f'
,
Owner of /
Building i • 1 ,2 .1
, 4 , f , • / '
i
.. '.
Architect
.
Contractor ,- .0
or Mitt& „e
Legal Lot /
Description -
Address of
Building
Bl.
Subdi-
vision
Value of
Project
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 revoked 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 responsibikify for a thorou h knowl dge of
the ordinances and regulations pertaining to the work covered hereby whether shown ,.9a thaltlattis or dravis
O or in tho:-statements o ecifica
e
that he assumes responsibility for work done by his agents, servants or employees. - - / , ::,-.4-;,/ ;-„;:,
''' Apii.degorae
to
Signed 4 -`
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In ac
ring thit permit I assume responsibility for all work dole b either my
e 14 * -4- 4 4- c NTRACTOR ILDER
•
Amt. of
Permit
lf, my agent, servant or employee. I
r
194
AUTHORITY
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
Registered Architect and /or Engineer
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ss.
No Street-- - - - -- - - — — — ---- - - - - - --
No •
(Signed)
Street
Employing Plumber's Name
Location and Legal Description Lot _ Block
Street and Number where work is to be performed —No
(Signed) ,
Subdivision
Street
State work to be perfu•tmed and purpose of building (By Floors)
y '
New Building __ ___ Remodeling Addition Repairs 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 Watcr Supply: City—Well ___ ______`__ -__Z _ Size of Soakage Pit
y
lumbing Inspectot`.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligationd as an employer '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.
t
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.
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
SINKS
SLOP
$INKS
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
SW IM'G
POOL
CONTR.
LIST
./
v
CHECK
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
Registered Architect and /or Engineer
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ss.
No Street-- - - - -- - - — — — ---- - - - - - --
No •
(Signed)
Street
Employing Plumber's Name
Location and Legal Description Lot _ Block
Street and Number where work is to be performed —No
(Signed) ,
Subdivision
Street
State work to be perfu•tmed and purpose of building (By Floors)
y '
New Building __ ___ Remodeling Addition Repairs 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 Watcr Supply: City—Well ___ ______`__ -__Z _ Size of Soakage Pit
y
lumbing Inspectot`.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligationd as an employer '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.
t
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.
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.
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _ _. _ -_ ` /2 Date y / '
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 _ __ #', No._,/ t
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot > Block Subdivisio
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 No. of Stories
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, }
ss.
COUNTY OF DADE.
Before me, the undersigned
appeared
MIAMI SHORES VILLAGE
r
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
(Signed)
authority, a notary public, duly authorized to
My Commission Expires
No Street
Street_
Street
--v
Capacity Gals l --- .
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
therein by him stated are true.
Notary Public, State of Florida
Plumbing Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
(Signed) -
Master Plumber.
administer oaths and take acknowledgments, personally
the same, and that all facts
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
SW IM'G
POOL
CONTR.
LIST
le..
CHECK
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _ _. _ -_ ` /2 Date y / '
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 _ __ #', No._,/ t
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot > Block Subdivisio
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 No. of Stories
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, }
ss.
COUNTY OF DADE.
Before me, the undersigned
appeared
MIAMI SHORES VILLAGE
r
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
(Signed)
authority, a notary public, duly authorized to
My Commission Expires
No Street
Street_
Street
--v
Capacity Gals l --- .
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
therein by him stated are true.
Notary Public, State of Florida
Plumbing Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
(Signed) -
Master Plumber.
administer oaths and take acknowledgments, personally
the same, and that all facts
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.
JOB:
BUILDING :
•
ELECTRICAL:
PLUMBING
•
Inspoctor's Report: -
: WORK
• DONE BY
The following is ready for Inspection: ..
4
: REQUESTED : WILL BE READY
•
• •
• •
• •
• •
• •
• •
• •
• •
• •
•
•
•
•
JOB: ! AD:
BUILDING •
: WORK
ELECTRICAL :
• DONE BY:
: REQUESTED
PLUMBING
Inspector's Report: --
•
•
•
The following is roady for Inspection: -
•
•
READY
•
•
71�
Permit No. ._
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
.y
APPLICATION FOR PLUMBING PERMIT
Date_ 4
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 world
Owner's Name and Address it
Registered Architect and /or Engineer _
t _{k
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed— No. __./
No /d Street__ C Y "S
lock
Street
Subdivision_ _11 A R 1 f S L &
State work to be performed and purpose of building (By Floors)
New Building Remodeling____ Addition Repairs
No. of Stories
Type of Tank. Capacity Gals
Feet of Drain Tile 1 Dist. Fret of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Size Septic Tank
Amount of Permit $______ - (Signed)
o
pl,tr abing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. /4 P
(Signed) �/1� �t
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.
ss.
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
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
I0
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
/
CONTR.
LIST
/
CHECK
f'
71�
Permit No. ._
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
.y
APPLICATION FOR PLUMBING PERMIT
Date_ 4
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 world
Owner's Name and Address it
Registered Architect and /or Engineer _
t _{k
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed— No. __./
No /d Street__ C Y "S
lock
Street
Subdivision_ _11 A R 1 f S L &
State work to be performed and purpose of building (By Floors)
New Building Remodeling____ Addition Repairs
No. of Stories
Type of Tank. Capacity Gals
Feet of Drain Tile 1 Dist. Fret of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Size Septic Tank
Amount of Permit $______ - (Signed)
o
pl,tr abing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. /4 P
(Signed) �/1� �t
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.
ss.
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.
tt5-"f A
•
ICI— 1t.:5(A..
)c.2 3 6 ‘A E 7S 7t
:- 3 - y1. 1 : 44 eyvt,
're-1A0
s I
I
APPLICATION FOR PLUMBING PERMIT
Permit No /4:2'1° �j ° Date .�i 51 J Z_! CS
4D ___
Application is hereby mad for t e approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. his ap lication 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 �/ , Al �+�+ c
Owner's Name and Address ____1__Sll.N__Sr__ _ �rr___C_a —y.t No. LO3�__ Street qc1_l��Z •____ —_ .
Registered Architect and /or Engineer
Employing Plumber's Name _ 5/_(
Location and Legal Description Lot
Street and Number where work is to be performed— No. /RS& 1 ' g _ _ _�i.1; Street
State work to be p and purpose of building (By Floors)
New Building Remodeling Addition Repairs. —___ No. of Stories
Size Septic Tank
Feet of Drain Tile
Nature of Watcr Supply: City —Well
55
Amount of Permit s-
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
lunlbing Inspect
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio as an employer labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, a as 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 ujler this permit, as are
licensed by Miami Shores Village.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
p - £
! N 1 i fl- - Street ` I /A- 1 _40 ?.
Block
to administer oaths
Subdivision____
(Signed) _
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized
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.
and take acknowledgments, personally
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.
Master Plumber.
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
■
r
CHECK
APPLICATION FOR PLUMBING PERMIT
Permit No /4:2'1° �j ° Date .�i 51 J Z_! CS
4D ___
Application is hereby mad for t e approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. his ap lication 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 �/ , Al �+�+ c
Owner's Name and Address ____1__Sll.N__Sr__ _ �rr___C_a —y.t No. LO3�__ Street qc1_l��Z •____ —_ .
Registered Architect and /or Engineer
Employing Plumber's Name _ 5/_(
Location and Legal Description Lot
Street and Number where work is to be performed— No. /RS& 1 ' g _ _ _�i.1; Street
State work to be p and purpose of building (By Floors)
New Building Remodeling Addition Repairs. —___ No. of Stories
Size Septic Tank
Feet of Drain Tile
Nature of Watcr Supply: City —Well
55
Amount of Permit s-
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
lunlbing Inspect
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio as an employer labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, a as 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 ujler this permit, as are
licensed by Miami Shores Village.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
p - £
! N 1 i fl- - Street ` I /A- 1 _40 ?.
Block
to administer oaths
Subdivision____
(Signed) _
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized
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.
and take acknowledgments, personally
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.
Master Plumber.
IP
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 ____----- ___ No. ,t/
STATE OF FLORIDA,
COUNTY OF DADE.
Registered Architect and /or Engineer ________ - --- -----____________________ -__________________ _______ _____ -__________ ------------------- _____ ------------------
Employing Plumber's Name _I ' - No Street
Location and Legal Description Lot — __Block
Street and Number where work is to be performed— Noi_e_j2__E'
State work to be performed and purpose of building (By Floors)
New Building_____________________ Remodeling Addition Repairs No. of Stories . ____ /__ _______
Date
Street
Size Septic Tank______! ___� �. Type of Tank ___ _reCe- Ese-e ►-
Feet of Drain Tile ,e__ - Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well .' Size of Soakage Pit.
--------------------------------
Amount of Permit $-- - - - - -- -. ____ —___ (Signed) _�
Capacity Gals 57e c/
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatlKns 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.
(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.
My Commission Expires Notary Public. State of Florida
Street_ ,
umb Ins tor.
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
y
CHECK
IP
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 ____----- ___ No. ,t/
STATE OF FLORIDA,
COUNTY OF DADE.
Registered Architect and /or Engineer ________ - --- -----____________________ -__________________ _______ _____ -__________ ------------------- _____ ------------------
Employing Plumber's Name _I ' - No Street
Location and Legal Description Lot — __Block
Street and Number where work is to be performed— Noi_e_j2__E'
State work to be performed and purpose of building (By Floors)
New Building_____________________ Remodeling Addition Repairs No. of Stories . ____ /__ _______
Date
Street
Size Septic Tank______! ___� �. Type of Tank ___ _reCe- Ese-e ►-
Feet of Drain Tile ,e__ - Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well .' Size of Soakage Pit.
--------------------------------
Amount of Permit $-- - - - - -- -. ____ —___ (Signed) _�
Capacity Gals 57e c/
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatlKns 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.
(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.
My Commission Expires Notary Public. State of Florida
Street_ ,
umb Ins tor.
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.
1
4 • •.
L , /03 �' ��•'�
MIAMI SHORES VILLAGE
Registered Architect and /or Engineer
Employing Plumber's Name __/ �� t: ' ' {� • --F ) tK •
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
7 f Permit No 411 _�_________ Date__ �_/ �
Application is hereby made for the approval of the detailed statement of the plans and specifications
structure herein described. This application is made in compliance and conformity with the Building
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all r
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of appro
building during progress of wor
Owner's Name and Address . j L_____ t _L_ t 4 No. � 36
G. •
Location and Legal Description Lot_____ __ t / lock
Street and Number where work is to be performed—No. 4e
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank
Feet of Drain Tile
C r G�
No._ _9
Dist. Feet of Tank or Drain Field from Well
herewith submitted for the building or other
Ordinance of Miami Shores Village, Florida,
ules and regulations of the Building Division
ved plans and specifications must be kept at
Street__
Street_ hr 7" !t
Subdivision_11 R ref S t'4
Repairs No. of Stories
Type of Tank Capacity Gals
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $ - --
(Signed)
•. ter' t ' ��
P ttbing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. �.� ^ :i N
(Signed) • ___�°Sr�
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.
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee $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
FIX ORES
CONTR.
LIST
-�_-1-
/
�"
)
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 'G
POOL
CONTR.
LIST
L
CHECK
L , /03 �' ��•'�
MIAMI SHORES VILLAGE
Registered Architect and /or Engineer
Employing Plumber's Name __/ �� t: ' ' {� • --F ) tK •
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
7 f Permit No 411 _�_________ Date__ �_/ �
Application is hereby made for the approval of the detailed statement of the plans and specifications
structure herein described. This application is made in compliance and conformity with the Building
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all r
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of appro
building during progress of wor
Owner's Name and Address . j L_____ t _L_ t 4 No. � 36
G. •
Location and Legal Description Lot_____ __ t / lock
Street and Number where work is to be performed—No. 4e
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank
Feet of Drain Tile
C r G�
No._ _9
Dist. Feet of Tank or Drain Field from Well
herewith submitted for the building or other
Ordinance of Miami Shores Village, Florida,
ules and regulations of the Building Division
ved plans and specifications must be kept at
Street__
Street_ hr 7" !t
Subdivision_11 R ref S t'4
Repairs No. of Stories
Type of Tank Capacity Gals
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $ - --
(Signed)
•. ter' t ' ��
P ttbing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. �.� ^ :i N
(Signed) • ___�°Sr�
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.
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
� `
/
.
L
`-'
r
ir
~