1201 NE 94 St (11)Permit No
Amount of Permit $_
STATE OF FLORIDA, }
C )LINTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' ,►,MIT
New Building Remodeling Addition
(Signed)
Capacity Gals
Notary Public, State of Florida
Date �.- i 4- C
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 Buildir,.g 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...J?- ..._..._t t -- . - � : - -1469',1 L _ Lt' f
- - -- Street--- `!-_ =- t 4
Registered Architect and /or Engineer ..... _______ _____T-___ ._-------.__.___--__--
Employing Plumber's Name 4- 2 -1
Location and Legal Description Lot---___--__--_ -- __-_--__-__ Blorti _.____._ Subdivision
Street and Number where work is to be performed —No._ -1_s.1 —! l Ldp ...� )
7_- c 1-176reet
State work to be performed and purpose of building (By Floors)__. - - - }S.. _._
Repairs No. of Stories... ........ .......
p t �s G,_ °,- - - �•� `
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
q
(Signed)_ 1411
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accep his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo • 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.
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-
ToRIE6
NKS
SINKS
SLOP
SINKS
LAUNDRY
TUSB
URINALS
I NAS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTD.
LIST
—
CHECK
—
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
1.1.4s 6
fA -�._`"
CHECK
Permit No
Amount of Permit $_
STATE OF FLORIDA, }
C )LINTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' ,►,MIT
New Building Remodeling Addition
(Signed)
Capacity Gals
Notary Public, State of Florida
Date �.- i 4- C
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 Buildir,.g 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...J?- ..._..._t t -- . - � : - -1469',1 L _ Lt' f
- - -- Street--- `!-_ =- t 4
Registered Architect and /or Engineer ..... _______ _____T-___ ._-------.__.___--__--
Employing Plumber's Name 4- 2 -1
Location and Legal Description Lot---___--__--_ -- __-_--__-__ Blorti _.____._ Subdivision
Street and Number where work is to be performed —No._ -1_s.1 —! l Ldp ...� )
7_- c 1-176reet
State work to be performed and purpose of building (By Floors)__. - - - }S.. _._
Repairs No. of Stories... ........ .......
p t �s G,_ °,- - - �•� `
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
q
(Signed)_ 1411
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accep his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo • 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.
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.
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