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PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 6 —a r Job Address l 0> Q 1 V c Tax Folio Legal Description ^� Owner / Lessee / Tenant s�% Art (-'F,O f`C_G; Master Permit # Owner's Address I E /� � Phone `d - 15.-S Contracting Co. r`Q"k� -S � Aer CQn r1Y i r - Address o2L O �W ) �� WORK DESCRIPTION a y as Owner and/or Condo President My Commis 'On Expires: APPROVED: Zoning Qualifier C,hy.Y\ 1 \l6 Phone a b - co? - 11 s 7 _ State # / (f a Municipal # Competency # 1 q 3 Ins.Co. A.t h frw Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBI MECHANICAL ROOFING PAVING PENCE =T"GN S Date: Mechanical Plumb Square Ft. Estimated Cost(value) 9gPt WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is'= -) ccurate and that all work will be done in compliance with all applicable laws regulating construc on and z• ing. Furthermore, I authorize the ab ve -na ed contractor to do the work stated. // gn ure gf owner and /or Condo President Signature of Contractor or Owner- Builder /// jl /Or Date: , ( / / / f /per" otary asz o Contractor or Owner- Builder My Comm' lion Expires: * * * * * * * * * * * ** FEES: PERMIT 3 RADON C.C.F. C NOTARY TOTAL DUE Fire Other Buildin;,� - / Electrical Engineering BUILDING ELECTRICAL PLUMBING / Owner of Building Architect Contractor or Builder Legal Lot Description Address of / Building f / r / / MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 9030 Work to be performed under this Permit Bl. Signed: Subdi- vision CONTRACTOR OR BUILDER BY Value of Project $ DATE 1951' Contractor's License No Amt. of Permit $ 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 one by his agents, servants or employees. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all drdinances and regulations aining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. Accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 9544 Work to be performed under this Permit Bl. Subdi- vision Value of Project $ Amt. of Permit $ 1951.2_ Contractor's License No 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 orOecifications and that he assumes responsibility for work done by his agents, servants or employees. CONTRACTOR OR BUILDER BY Signed: a. ,r . d , BY /` / _. _.. _. INSPECTOR,._ In consideration of the issuance to me of this permit I agree to perfo '' . + k - covereei+•ber compliance with all 'ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, star ecfficatzrdq'�` tls ntsa. . proper authorities' of Miami Shores Village. In accepting this permit I assume responsibility for all work done by ither +.e , r gently servant or '' o ee. AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor 1 or Builder Legal Description Address of Building f Lot MIAMI SHORES VILLAGE, FLORIDA fl i PERMIT N° 9575 Work to be performed under this Permit } i 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 statemen or specifications and that he assumes responsibility for work done by his agents, servants or employees. \, Signed • r /- BY INSPECTOR In consideration of the issuance to me of this permit I agree to . pe orm the work covered hereunder in compliance with aleo fina and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities df Miami Shores Village. In ccepting thisrmissume responsibj a / ll work, done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER; "%' BY Bl. Subdi- vision Value of Project $ DATE'} 195 Contractor's License No. _ Amt. of Permit $ / ,L AUTHORITY Y Penni; No. ! .L ....._. Amount of Permit $ • STATE OF FLORIDA, ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application k hereby made for the approval of the detailed statement of the plans and specifications herewith subr.uu,.,A for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of MI: •i Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec. fications must be kept at ',adding during progress of work. Jwner's Name and Address.. ..__ C 1l2[ , .c� __...,..._.._. No., /') Z. • . egistsred Architect and /or Engineer :mploying Plumber's Name M!.>> M O � ' eeJ ... Tle ,gMC . — No.. - ` 7 a ........ Street... �„,... Location and Legal Description Lot. Block SubdivIzon.._.. Street and Number where work is to be performed —No /070 Str N� State work to be performed and purpose of building (By Floors) _ -../ - . s � � , `�1. � . t ' � C ' ' / - - - - . . . . . . . . . . . . New Building ........... ____ ............... Remodeling_._ _ ..... _._ Addition..._.-... Repairs V No. of Stones Size Septic Tank_..__ _. - - - -•_ -.__ -- ._...Type of Tank -- Capacity ^ eels. Feet of Drain Tile.__.___ __ _- _.__._Dist. Feet of Tank or Drain Field from Well. Nature of Water Supply: City — Well._____ _ _ _._ of Soakage Pit (Signed)_ (Signed Date _ 3 h 7 Czd. Street_. _._..... Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a ndloyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent rum lement, and ha. •. ors• i.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in 'al rk 'o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work su publ: notice 1: no firer . +s al required by the Act. The undersigned agrees to employ only such sub- contractors, % . k to be iii +' ed '.;x this .1 :r1.ut, x: at . licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per,orr; ; . ppear±'r.. 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 be has carefully read the foregoing application, and that he did sign the same, and that all acts therein by him stated are true. My Conunission Expires Notary Public, State of Florida Mesta Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re-inspection V made•neoessary by improper notice for fnspecton, tls wilt) materials and /or workmanship. CLOSETS BATH Tull, SNOWIER* LAVA. TORIES 6 " 4 " SLOP SINKS LAUNDRY Tune URINAL/ CATCH BASIN FLOOR D RAIN DRINKING FOUNT•NS TOT,.L rlllrl RE* CONTA. LI'T CHECK SEPTIC TANK SEWER CONN. DRAIN r1ELD SOAKAGE PIT GREASE TRAP SOLAR N EATER DEEP WELL 8PRKLR. SYSTEM SWIM POOL i CONTIt. LIST .� - -.—� -- r — T — , CHICK ■ Y Penni; No. ! .L ....._. Amount of Permit $ • STATE OF FLORIDA, ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application k hereby made for the approval of the detailed statement of the plans and specifications herewith subr.uu,.,A for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of MI: •i Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec. fications must be kept at ',adding during progress of work. Jwner's Name and Address.. ..__ C 1l2[ , .c� __...,..._.._. No., /') Z. • . egistsred Architect and /or Engineer :mploying Plumber's Name M!.>> M O � ' eeJ ... Tle ,gMC . — No.. - ` 7 a ........ Street... �„,... Location and Legal Description Lot. Block SubdivIzon.._.. Street and Number where work is to be performed —No /070 Str N� State work to be performed and purpose of building (By Floors) _ -../ - . s � � , `�1. � . t ' � C ' ' / - - - - . . . . . . . . . . . . New Building ........... ____ ............... Remodeling_._ _ ..... _._ Addition..._.-... Repairs V No. of Stones Size Septic Tank_..__ _. - - - -•_ -.__ -- ._...Type of Tank -- Capacity ^ eels. Feet of Drain Tile.__.___ __ _- _.__._Dist. Feet of Tank or Drain Field from Well. Nature of Water Supply: City — Well._____ _ _ _._ of Soakage Pit (Signed)_ (Signed Date _ 3 h 7 Czd. Street_. _._..... Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a ndloyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent rum lement, and ha. •. ors• i.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in 'al rk 'o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work su publ: notice 1: no firer . +s al required by the Act. The undersigned agrees to employ only such sub- contractors, % . k to be iii +' ed '.;x this .1 :r1.ut, x: at . licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per,orr; ; . ppear±'r.. 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 be has carefully read the foregoing application, and that he did sign the same, and that all acts therein by him stated are true. My Conunission Expires Notary Public, State of Florida Mesta Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re-inspection V made•neoessary by improper notice for fnspecton, tls wilt) materials and /or workmanship. Size Septic Tank 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 1Vliarni 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 co lied 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 Enginee Employing Plumber's Name ✓ ' * = ` No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to lie performed —No � � ' "'4 S State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 2 Feet of Drain Tile /- Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. S s. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank �✓ r �_ _�____ Dist. 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 and stands and accepts his obligkt s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gener 1 Laws of Florida Permanent S, + • ment, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors iployed by him 11 ,e work to be performed under this permit; and will post or cause to be posted for inspection on* the site of the w k ich public notice or no es as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work e erfnrmed under this ermit, as are licensed by Miami Shores Village. f j 9 No Street Capacity Gals My Commission Expires Notary Public, State of Florida ) Master leumber. 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 �' P Size Septic Tank 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 1Vliarni 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 co lied 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 Enginee Employing Plumber's Name ✓ ' * = ` No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to lie performed —No � � ' "'4 S State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 2 Feet of Drain Tile /- Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. S s. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank �✓ r �_ _�____ Dist. 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 and stands and accepts his obligkt s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gener 1 Laws of Florida Permanent S, + • ment, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors iployed by him 11 ,e work to be performed under this permit; and will post or cause to be posted for inspection on* the site of the w k ich public notice or no es as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work e erfnrmed under this ermit, as are licensed by Miami Shores Village. f j 9 No Street Capacity Gals My Commission Expires Notary Public, State of Florida ) Master leumber. 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 C. /� •� New Building t/ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 3 — 1 — 5 o 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 I " / ' K /A/ Y No Street Registered Architect and /or Engineer Midland Plumbing, Inc. � S G 0 Street_ _ _ : / f T� to o Employing Plumber's Name No i Location and Legal Description Lot 3 Block Subdivision_C l R $ Y-f Street and Number where work is to be performed —No / 6 7 d Street N. E_ 9 ..- .5 State work to be performed and purpose of building (By Floors) f a/ F 5 '; ' ‘ " % !`". i� FN G F Remodeling Addition Repairs No. of Stories a•vE 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 Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss. ( Signed) (Signed . 7, The undersigned applicant for this building permit does hereby certify that he un stands and accepts his obligations 4n 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • robing Inspector. 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. 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 C L ST J 1 I Z 1 • CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL t-l• e C. 4 'Ai di- CONTR. LIST / / CHECK Permit No C. /� •� New Building t/ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 3 — 1 — 5 o 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 I " / ' K /A/ Y No Street Registered Architect and /or Engineer Midland Plumbing, Inc. � S G 0 Street_ _ _ : / f T� to o Employing Plumber's Name No i Location and Legal Description Lot 3 Block Subdivision_C l R $ Y-f Street and Number where work is to be performed —No / 6 7 d Street N. E_ 9 ..- .5 State work to be performed and purpose of building (By Floors) f a/ F 5 '; ' ‘ " % !`". i� FN G F Remodeling Addition Repairs No. of Stories a•vE 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 Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss. ( Signed) (Signed . 7, The undersigned applicant for this building permit does hereby certify that he un stands and accepts his obligations 4n 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • robing Inspector. 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. 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. Permit No 9 , 7 'AAA*/ Owner's Name and Address -- -- i Amount of Permit $__/ Z 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. pi p Registered Architect and /or Engineer ,�� Employing Plumber's Name/ _'. ✓ !" r_ a No Street / . �2 6 C/,� 5 !!! Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street 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 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 (Signed) The undersigned applicant for this building permit does hereby certify that he i nd rstands and accepts his obli rf ns 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. , (Signed Date G .2- No Street / 7 4 E 7 My Commission Expires Notary Public, State of Florida Plumbing Inspector. Master Plumb STATE OF FLORIDA, ss. 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 SW IM'G POOL C CONTR. LIST ' 'F ) CHECK Permit No 9 , 7 'AAA*/ Owner's Name and Address -- -- i Amount of Permit $__/ Z 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. pi p Registered Architect and /or Engineer ,�� Employing Plumber's Name/ _'. ✓ !" r_ a No Street / . �2 6 C/,� 5 !!! Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street 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 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 (Signed) The undersigned applicant for this building permit does hereby certify that he i nd rstands and accepts his obli rf ns 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. , (Signed Date G .2- No Street / 7 4 E 7 My Commission Expires Notary Public, State of Florida Plumbing Inspector. Master Plumb STATE OF FLORIDA, ss. 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.