1066 NE 94 St (3)1/11.e V -
PLUZL,LuG L.'SPLCTIO
Pc=it
'J'ork done by /
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Oviner
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Drainff
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Ti.030iViid by
Datc
Time
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New Building Remodeling
Size Septic Tank
Feet of Drain Tile______
s s.
(Sign
MJAM I SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Permit r' is hereby made for :he approval of the detailed statement of the plans and specifications herewith submitted for the building or other
More 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.
t.
b 4, a •v / %
,/ � r f a"
.
Owner's Name and Address ' ` No./ ` q if ., L Street
P "1:' ( r
Registered Architect and /or E • ' r _ ..L "'Y' _ r!4''!"!___ _`_.4_t�/ '"'" r ' 'A` '"'°�
Employing Plumber's Name _ C x � A �'rti :,. 0 / � 4.4 > • 1_ "street ‘7,i - . /r %-
F �j
Location and Legal Description Lot , ` -4- j � i Block Subdivision_ _ _�' ^' ' +__ _! ►�_ /
A '
Street and Num where work is to be performed —No. __ / e � _ - __:____ - _ _ Street _ '?�
State work to be performed and purpose of building (By Floors) _
Addition Repairs
Nature of Water Supply: City —Well .Size of Soakage Pit.
`. e C
Amount of Permit $_____ (Signed)
No. of Stories
Type of Tank _: - Capacity Gals
Dist. Feet of Tank or Drain Field from 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 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 s»ch sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
s �'i,Fiffl;
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acl(stowledgments, personally
Master Plumber.
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
My Commission Expires
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
F LOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
,y(
�/
CHECK
New Building Remodeling
Size Septic Tank
Feet of Drain Tile______
s s.
(Sign
MJAM I SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Permit r' is hereby made for :he approval of the detailed statement of the plans and specifications herewith submitted for the building or other
More 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.
t.
b 4, a •v / %
,/ � r f a"
.
Owner's Name and Address ' ` No./ ` q if ., L Street
P "1:' ( r
Registered Architect and /or E • ' r _ ..L "'Y' _ r!4''!"!___ _`_.4_t�/ '"'" r ' 'A` '"'°�
Employing Plumber's Name _ C x � A �'rti :,. 0 / � 4.4 > • 1_ "street ‘7,i - . /r %-
F �j
Location and Legal Description Lot , ` -4- j � i Block Subdivision_ _ _�' ^' ' +__ _! ►�_ /
A '
Street and Num where work is to be performed —No. __ / e � _ - __:____ - _ _ Street _ '?�
State work to be performed and purpose of building (By Floors) _
Addition Repairs
Nature of Water Supply: City —Well .Size of Soakage Pit.
`. e C
Amount of Permit $_____ (Signed)
No. of Stories
Type of Tank _: - Capacity Gals
Dist. Feet of Tank or Drain Field from 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 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 s»ch sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
s �'i,Fiffl;
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acl(stowledgments, personally
Master Plumber.
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
My Commission Expires
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.
r
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19- 1171!
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