PLUMBINGApplication is hereby mode 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.
Permit No
Owners Name and Address
Registered Architect and /or Engineer
Employing Plumber's Nam
Location and Legal Description . Blork Subdivision
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__
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.
0
- .02
Amount of Permit $
STATE OF FLORIDA,
ss
COUNTY OF DADE. f .
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
�D
No/
Street...., ._,9i trfr
Repairs No. of Stories. ......
_ Capacity Gals._._
(Signed)
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl' ons 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 perfo d under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly anthorized 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
materNialOTE: re-in hi pee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
CLOSETS
BATH
Tuns
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINK•
LAUNDRY
Tues
URINALS
CATCH
BASIN
FLOOR
DRAIN
—'
DRINKING
FOUNT'Ne
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•O
POOL
CONTR.
LIST
CHECK
Application is hereby mode 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.
Permit No
Owners Name and Address
Registered Architect and /or Engineer
Employing Plumber's Nam
Location and Legal Description . Blork Subdivision
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__
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.
0
- .02
Amount of Permit $
STATE OF FLORIDA,
ss
COUNTY OF DADE. f .
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
�D
No/
Street...., ._,9i trfr
Repairs No. of Stories. ......
_ Capacity Gals._._
(Signed)
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl' ons 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 perfo d under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly anthorized 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
materNialOTE: re-in hi pee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty