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PLUMBINGPermit No M SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 1 3 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. _ / 06 0 S tree�._ v E 9 ■5f Owner o Name and Address , ° l rt 1S aVI Registered Architect and /or Engineer Employing Plumber's Name PA..I A t .l l..'. Location and Legal Description Lot. 1® 0 No. Size Septic Tank_ -- - - - --_ _..__. —..__ _ _...Type of Tank Feet of Drain Tile._.___ _ Y___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__ _-- .--- ____ -- -- -- -- -Size of Soakage Pit aka Ai t Subdivision. Street and Number where work is to be performed —No Street 1 State work to be performed and purpose of building (By Floors)__ -- -- LL j —_. 2 -.. LO'U` ' ... - ...... New Building *__ Remodeling_ —_ _ _____ Addition_. -_____. Repairs No. of Stories (Signed)_ (Si Capacity Gals... Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga6n as an employer of labor under the Florida Worlanen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and Ilan com- plied with the provisions thereof, and will require similar compliance from all oontractors or sub - contractors ed 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 . ch p •lic notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on j to perf . , ed u this permit, as arq /foamed by Miami Shores Village. / STATE OF FLORIDA, COUNTY OF DADE. b 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 de-poses and stays that he is the- -•--- ......... - .. ..... . .. . ... _ _.. of the above described construction, that he has carefully =ad the foregoing appllcatfon, and that he did sign the same, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of 01.00 will he madly ahz (=I m4nsspeotinst l snade'oeos:sary by improper notice for inspection, or faulty matori.als and/o3 workmanship. CLOSETS BATH TUB S SHOW ERO LAVA. TORTE : B I N" SLOP SINKS LAUNDRY Tula URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NO TOTAL FIXTURES CONTR. LIST CHECK _ -- - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL sPRKLII. SYSTEM SWIM'O POOL CONTR. LIST CHECK Permit No M SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 1 3 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. _ / 06 0 S tree�._ v E 9 ■5f Owner o Name and Address , ° l rt 1S aVI Registered Architect and /or Engineer Employing Plumber's Name PA..I A t .l l..'. Location and Legal Description Lot. 1® 0 No. Size Septic Tank_ -- - - - --_ _..__. —..__ _ _...Type of Tank Feet of Drain Tile._.___ _ Y___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__ _-- .--- ____ -- -- -- -- -Size of Soakage Pit aka Ai t Subdivision. Street and Number where work is to be performed —No Street 1 State work to be performed and purpose of building (By Floors)__ -- -- LL j —_. 2 -.. LO'U` ' ... - ...... New Building *__ Remodeling_ —_ _ _____ Addition_. -_____. Repairs No. of Stories (Signed)_ (Si Capacity Gals... Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga6n as an employer of labor under the Florida Worlanen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and Ilan com- plied with the provisions thereof, and will require similar compliance from all oontractors or sub - contractors ed 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 . ch p •lic notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on j to perf . , ed u this permit, as arq /foamed by Miami Shores Village. / STATE OF FLORIDA, COUNTY OF DADE. b 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 de-poses and stays that he is the- -•--- ......... - .. ..... . .. . ... _ _.. of the above described construction, that he has carefully =ad the foregoing appllcatfon, and that he did sign the same, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of 01.00 will he madly ahz (=I m4nsspeotinst l snade'oeos:sary by improper notice for inspection, or faulty matori.als and/o3 workmanship.