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374 NE 95 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7 Job Address uJ 7 L �/ S+ Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant AND n,ect) Du tot A.. Master Permit # /() Owner's Address 3 7 Li 1 e 9 ,c 3 j M( S 4eS Phone 75 f / //ci Contractin Co. ' 9'S Cop( 1 / �" 7 /t 5 Address (0.21 5w / 8o ct--) Qualifier A• 't# "/ / /7 ( o J 97, State __�_v_ >3 Municipal # Competency # Ins. Co. 7 Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICA WORK DESCRIP'T'ION cyit. Loll 1{,cet6c4ik Square Ft. 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 accurate and that all work will be done in compliance with all applicable laws regulating cons . ion and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Zoning 7 w as to 0 :++ •t :' ondo esident Date as to Contra My � is to : Co - , ,, My mmissio;. hlvi1 1Q .l NO. r 4 RADON Date Address Address Address PLUMBIN MECHANICAL ROOFING PAVING FENCE GN 0 C.C.F. 1:31.ecAi.c (4)- (-0 D e i 11?ev"FilvG� LA�!,�vt�G4s Estimated Cost (value) &• f Co • actor or 0 er -B ' • er NOTARY TOTAL DUE Date Permit No. Owner's Name and Address STATE OF FLORIDA, COUNTY OF DADE. ss. Employing Plumber's Name _ ft R 1(13_ i Location and Legal Description Lot +.1 ! St Street and Number where work is to be performed —No. 3 Amount of Permit $-- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 2 — — 4 +�— — -- 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. No Registered Architect and /or Engineer 7 State work to be performed and purpose of building (By Floors) New Building Y Remodeling Street_C ► f 0 Suubddivisiot Q /$1 4 f 00 6 6 Street-11 •Z • / S No.L1 Block --_ . Addition (Signed) 3.744 Street- ^ £ ST _(Signed) Repairs No. of Stories '~ Type of Tank Capacity Gals Size Septic Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit. 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 such sub - contractors, on work to be . rformed under this permit, as are licensed by Miami Shores Village. Master Plumber. Notary Public. State of Florida 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 SHO 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 Permit No. Owner's Name and Address STATE OF FLORIDA, COUNTY OF DADE. ss. Employing Plumber's Name _ ft R 1(13_ i Location and Legal Description Lot +.1 ! St Street and Number where work is to be performed —No. 3 Amount of Permit $-- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 2 — — 4 +�— — -- 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. No Registered Architect and /or Engineer 7 State work to be performed and purpose of building (By Floors) New Building Y Remodeling Street_C ► f 0 Suubddivisiot Q /$1 4 f 00 6 6 Street-11 •Z • / S No.L1 Block --_ . Addition (Signed) 3.744 Street- ^ £ ST _(Signed) Repairs No. of Stories '~ Type of Tank Capacity Gals Size Septic Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit. 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 such sub - contractors, on work to be . rformed under this permit, as are licensed by Miami Shores Village. Master Plumber. Notary Public. State of Florida 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./ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 No Street____ Registered Architect and /or Engineer Employing Plumber's Name — No Street 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______ Feet of Drain Tile_____ Type of Tank ._____.____.. Capacity Gals.__ —____ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit __ (Signed) The undersigned applicant for this building permit does hereby certify that ,l a 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 such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, 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. My Commission Expires Notary Public. State of Florida Plumbing Inspector. Master Plumber. 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 FI %TORES 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 Permit No./ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 No Street____ Registered Architect and /or Engineer Employing Plumber's Name — No Street 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______ Feet of Drain Tile_____ Type of Tank ._____.____.. Capacity Gals.__ —____ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit __ (Signed) The undersigned applicant for this building permit does hereby certify that ,l a 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 such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, 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. My Commission Expires Notary Public. State of Florida Plumbing Inspector. Master Plumber. 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. • MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT f Permit No./.__ f APPLICATION FOR PLUMBING PERMIT Date__/_ ! 2 �/ 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. ,r\ / �✓ Owner's Name and Addres�r �,. t__ .' �LL 5.4"—eto No Street Registered Architect and /or Engilteer __ ___ i Employing Plumber's Name' -tC 2_ —_: Location and Legal Description Lot_____ _2____1!'____— ______ / ___Block ."`/ Street and Number where work is to be performed —No ...:'__ " " . 7 State work to be performed and purpose of building (By Floors) - New Building ____________________________ Remodeling Addition Repairs No. of Stories Street/_ _ AiLeQAl !__ �"!+ trees eh2 - - ° =�- 1 — - - -- Size Septic Tank_ — _____ Type of Tank . Capacity Gals._ -"e'Q Feet of Drain Tile ____ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit t ) (7- Amount of Permit t_ STATE OF FLORIDA, COUNTY OF DADE. j ss. _(Signed) s- (Signed) - 1‘ 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 such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. J / 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 Master Plumber. 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 Tuas 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 v � DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK • MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT f Permit No./.__ f APPLICATION FOR PLUMBING PERMIT Date__/_ ! 2 �/ 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. ,r\ / �✓ Owner's Name and Addres�r �,. t__ .' �LL 5.4"—eto No Street Registered Architect and /or Engilteer __ ___ i Employing Plumber's Name' -tC 2_ —_: Location and Legal Description Lot_____ _2____1!'____— ______ / ___Block ."`/ Street and Number where work is to be performed —No ...:'__ " " . 7 State work to be performed and purpose of building (By Floors) - New Building ____________________________ Remodeling Addition Repairs No. of Stories Street/_ _ AiLeQAl !__ �"!+ trees eh2 - - ° =�- 1 — - - -- Size Septic Tank_ — _____ Type of Tank . Capacity Gals._ -"e'Q Feet of Drain Tile ____ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit t ) (7- Amount of Permit t_ STATE OF FLORIDA, COUNTY OF DADE. j ss. _(Signed) s- (Signed) - 1‘ 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 such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. J / 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 Master Plumber. 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. BUILDING ELECTRICAL PLUMBING • • • • Inspector's Report: - JOB: AD: WORK DONE BY REQUESTED The following is ready for Inspection: WILL BE READY s • 0 Amount of Permit Si,- es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 , No Street Registered Architect and /or Engineer __ .__�: Employing Plumber's Name Location and Legal Description Lot_ 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 Repairs No. of Stories Size Septic Tank__________ ____ Type of Tank Feet of Drain Tile_ Dist. Feet of Tank or Drain Field from Well__ No. - / Street.. _Block Subdivision______,e___ _= Street i ' ' ---- -�_ - -- Capacity Gals e Nature of Water Supply: City —Well. Size of Soakage Pit. (Signed) (Signed) I' - aster`'P1u nber. 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 such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 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. 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 FCUNT•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 � / Amount of Permit Si,- es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 , No Street Registered Architect and /or Engineer __ .__�: Employing Plumber's Name Location and Legal Description Lot_ 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 Repairs No. of Stories Size Septic Tank__________ ____ Type of Tank Feet of Drain Tile_ Dist. Feet of Tank or Drain Field from Well__ No. - / Street.. _Block Subdivision______,e___ _= Street i ' ' ---- -�_ - -- Capacity Gals e Nature of Water Supply: City —Well. Size of Soakage Pit. (Signed) (Signed) I' - aster`'P1u nber. 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 such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 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. 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. Nature of Water Supply: City—Well. Y Y —Well. est. MIAMI SHORES VI LLAG E 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 Owner's Name and Address __ ti..:! � __L!11!!__ � ____`_ Registered Architect and /or Ep�neef _ Plumber's Name Location and Legal Description Lot____ Street and Number where work is to be performed —No Amount of Permit $ licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires No Street No Street_d_/ Subdiv n Street !__ State work to be performed and purpose of building (By Floors) 1__ I / Date New Building Remodeling Addition Repairs No. of Stories Size Septic Tank —__� _C ___ ______ Type of Tank . Capacity Gals S:/fe! Feet of Drain Tile__ —__ � F of Tank or Drain Field from Well • Size of Soakage Pit - (Signed) — – - - - - -- – -- — 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 wo a -satlr yublicnotice pr�otices as are required by the Act. The under signed agrees to employ only such sub - contractors, on r c erf u er t s rmit, as are (Signed) ' Notary Public. State of Florida Iaster ber. 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 t J Permit No. Nature of Water Supply: City—Well. Y Y —Well. est. MIAMI SHORES VI LLAG E 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 Owner's Name and Address __ ti..:! � __L!11!!__ � ____`_ Registered Architect and /or Ep�neef _ Plumber's Name Location and Legal Description Lot____ Street and Number where work is to be performed —No Amount of Permit $ licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires No Street No Street_d_/ Subdiv n Street !__ State work to be performed and purpose of building (By Floors) 1__ I / Date New Building Remodeling Addition Repairs No. of Stories Size Septic Tank —__� _C ___ ______ Type of Tank . Capacity Gals S:/fe! Feet of Drain Tile__ —__ � F of Tank or Drain Field from Well • Size of Soakage Pit - (Signed) — – - - - - -- – -- — 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 wo a -satlr yublicnotice pr�otices as are required by the Act. The under signed agrees to employ only such sub - contractors, on r c erf u er t s rmit, as are (Signed) ' Notary Public. State of Florida Iaster ber. 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. e J 77 JOB: AD: BUILDING ELECTRICAL PLUMBING Inspector's Report: - • • WORK DONE BY • • • The following is ready for Irispection: • • REQUESTED • • • • • • • • WILL BE READY JOB: BUILDING ELECTRICAL PLUMBING • • • • Inspector's Report: - • • • AD: WORK DONE BY The following is ready for Inspection: • FEUESTED • WILL BE READY • • • • Permit No _ - -1_ c--1 - C Application i hereby made for the approval of the detailei statement of the plans and specifications herewith submitted for the build ng 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 th Building Du lion of M'ami 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. l Owner's Name and Address_ 6! 'S //V. e - •.- _- - - - - -- No.- - - - - -- / -- Street _ _ !v_-L° _ 9 ' Registered Architect and /or E 'neer _ . _ __ _ Employing Plumber's Name � � ;L _GO No._ _II_ [ ____-_-- _ _ Street _ M g J Location and Legal Description Lot__________ _ _ _ _____ —/— — _ Bloch Subdivision_ Str N / _. ?S .0 nV - r Street and Number where work is to be performed —No __ State work to be performed and purpose of building (By FIcaxs) New Building —_ -_- _ - - -• - -. _._ Remodeling____ ___ __ __ - yddition____ Amount of Permit $ _ _ 5012 -- -- STATE OF FLORIDA, ss. COUNTY OF DADE. MIA v,0 SHORES VILLAGE PLUM Di e ONSPECTION DEPARTMENT APPLiCAU M9 FOR PLUMBING PERMIT - /3 Size Septic Tank___ _ __ __ __ _ _ Feet of Drain Tile_ _ . _____ __ __ - __ _ -_ _ . __ _Dist. Feet of Tank or Drain Field from Well.. Nature of Water Supply. City —Well. __ _ Si " of Soakage Pit ( Signed) __. - Date _ _.. No. of Stories - - Capacity Gais. The undersigned applicant for this building permit does hereby certify that he understands and ccc. pts his obliga•'o.,: as an e nployer of labor under Florida Workmen's Compensation Act, being Section 5969, Compiled General Laws of Florida Penman pplz-ment, and 1.i, 'om plied with the-provisions. thereof, and will require similar compliance from all contractors or sub - contractors empl.' by hin in the work to be performed under this permit; and will post or cause to be posted' fox inspection on the site of the work such public notice or no ices as are required by the Act. The undersigned agrees to employ only such sub contractors, on w o be perfo. ed under this per n t, as are licensed by Miami Shores Village. _ ng In:pecto. Master Plumber. Before me, the undersigned authority, a notary public, (lily authorized to administer oaths and take acknowledge eats, personall 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 .acts therein by him stated are true. My Commission Expires Notary Public, State of Florida r - NOTE: A re- inspection fee of $1.00'webe made whun 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 SIMKO LAUNDRY it, / AKOF URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUR'T'NB TOTAL F %TUREB CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP lfWE.L SPRKLR. SYSTEM SWIM'G P001. CONTR. LIST CHECK -- Permit No _ - -1_ c--1 - C Application i hereby made for the approval of the detailei statement of the plans and specifications herewith submitted for the build ng 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 th Building Du lion of M'ami 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. l Owner's Name and Address_ 6! 'S //V. e - •.- _- - - - - -- No.- - - - - -- / -- Street _ _ !v_-L° _ 9 ' Registered Architect and /or E 'neer _ . _ __ _ Employing Plumber's Name � � ;L _GO No._ _II_ [ ____-_-- _ _ Street _ M g J Location and Legal Description Lot__________ _ _ _ _____ —/— — _ Bloch Subdivision_ Str N / _. ?S .0 nV - r Street and Number where work is to be performed —No __ State work to be performed and purpose of building (By FIcaxs) New Building —_ -_- _ - - -• - -. _._ Remodeling____ ___ __ __ - yddition____ Amount of Permit $ _ _ 5012 -- -- STATE OF FLORIDA, ss. COUNTY OF DADE. MIA v,0 SHORES VILLAGE PLUM Di e ONSPECTION DEPARTMENT APPLiCAU M9 FOR PLUMBING PERMIT - /3 Size Septic Tank___ _ __ __ __ _ _ Feet of Drain Tile_ _ . _____ __ __ - __ _ -_ _ . __ _Dist. Feet of Tank or Drain Field from Well.. Nature of Water Supply. City —Well. __ _ Si " of Soakage Pit ( Signed) __. - Date _ _.. No. of Stories - - Capacity Gais. The undersigned applicant for this building permit does hereby certify that he understands and ccc. pts his obliga•'o.,: as an e nployer of labor under Florida Workmen's Compensation Act, being Section 5969, Compiled General Laws of Florida Penman pplz-ment, and 1.i, 'om plied with the-provisions. thereof, and will require similar compliance from all contractors or sub - contractors empl.' by hin in the work to be performed under this permit; and will post or cause to be posted' fox inspection on the site of the work such public notice or no ices as are required by the Act. The undersigned agrees to employ only such sub contractors, on w o be perfo. ed under this per n t, as are licensed by Miami Shores Village. _ ng In:pecto. Master Plumber. Before me, the undersigned authority, a notary public, (lily authorized to administer oaths and take acknowledge eats, personall 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 .acts therein by him stated are true. My Commission Expires Notary Public, State of Florida r - NOTE: A re- inspection fee of $1.00'webe made whun such re-inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde -Legal Descripti Address CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE / Contractor's License No. PERMIT ■9 1785 ork to be performed under this Permit ,/ Building _ This permit is 6antel to c ontractor 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 wings or in the statements or specifications and That he assumes responsibility for work done by his agents, servants or employees. - Signed• INSPECTOR 1 In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- ins pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores 'llage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY 1941 >r r C �, ' e t / V ' //7 ,n Lot /A /� �„ BI. /L -� Subdi- vision )f �/� /' ! ' .) � � Value of Project Amt. of Permit /..& BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde -Legal Descripti Address CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE / Contractor's License No. PERMIT ■9 1785 ork to be performed under this Permit ,/ Building _ This permit is 6antel to c ontractor 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 wings or in the statements or specifications and That he assumes responsibility for work done by his agents, servants or employees. - Signed• INSPECTOR 1 In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- ins pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores 'llage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY 1941 "'UILDING LLECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 1611 Work to be performed under this Permit Owner Building of { "- ` L,t�•� ` �.f-� Architect Contractor or Builder Legal Lot f ---° sd ..:Deseription Address of "` / 1. I, Building - �.-, Bl. r • 1�O Subdi- vision Value of Project D J DATE IIIIII 194__,L_ 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 assume the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or vings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. `4 By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.,. Iq.eccepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. 7 t CONTRACTOR OR BUILDER BY AUTHORITY Amt. of Permit BUILDING ELECTRICAL PLUMBING Owner of Building egal Lot Bl. p Address of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 1764 Work to be performed under this Permit Architect Contractor or Builder t escri [ion " .r• Subdi- vision Value of Project DATE; - ��i Contractor's License No. Amt. of Permit 194 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 done by his agents, servants or employees. Signed• By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- a tions pertaining the Village. In accepting CONTRACTOR OR BUILt R BY AUTHORITI MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ * ELECTRICAL ❑ DATE 19 PLUMBING ❑ PERMIT N° 9 712 Contractor's License No ROOFING ❑ ❑ Work to be performed under this Permit_ Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot I • Bi. c Subdi- vision Amt. of Permit $ Sq. Ft Value of Project $ 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 done by his agents, servants or employees. f{ Signed: ' i BY • INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 1,1e I CONTRACTOR OR BUILDER BY AUTHORITY fin» �•�� ......m u C:t -13,27, OATH Tuas SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUN•NS TOTAL FIXTURES CO:V'TR- LIST CHECU ...... 6.^.PTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE P 1T GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CcwtR. LIFT - CHECK APPLICATION FOR PLUMBING PERMIT i'srrui' No.. _ (✓ - -f _ Date,..._ „ Application is hereby a,zs le for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other etraxcture -herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, allrad 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 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. O:vner's Name and Address ........ —i_- ....L - i J Registered Architect and /or Engineer - ---_ �-- -_ -- -- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT , Employing Plumber's Name :' ._ / 1r > : L r Amount of Permit $- r _i — _ —____ (Signed)___ My Commission Expires No. ___ Street Block_ Location and Legal Description Lot.__ ;i,treet sad Number where work is to be performed —No.__ / _ _ � Street < State work to be performed) an or d purpose of building (By Flows) _ - -__ .27 ---- a .'-_.__ _ _ L r ey- v L t -e. New Building ___ Remodeling____ _ Addition_______._ Repairs o.--- No. of Stories. Size Septic Tank __ - -- Type of Tank_ —_. Capacity Gals. s Feet of Drain . Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well._______ _ ____..Size of Soakage Pit Street_ / ................ Subdivision 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 5968, Compiled General Laws of Florida Permanent Supplement, and Ilas 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 ramt by the Act. The undersigned agrees to employ only such sub - contra ors, on work be performed under this permit, as are licensed by Miami Shores Village. / (Signed),—.' % i � ; ',Master Plumber. STATE OF FLORIDA, ( es. 1 COUNTY OF DADE. (( / Before me, the undersigned authority, a notary public, duly authorized to add /mister 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. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re inspection is made•neoessary by improper notice for inspection, or faulty Materials and /or warkmanchip. Permit No e-7 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address t jV C 1( L EO\ Registered Architect and /or Engineer y Employing Plumber's Name.../3�.l.Ft~�f✓��L t ( No,. .f. 21. .. m ., „„„ street. .:. /. Location and Legal Description Lot_ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building ----- .-- • - -••- -- - -.._ Remodeling____ — ..._ -_ Addition...- ...__. Repairs No. of Stories Sine Septic Tsnls ._.--------- - - - - -- - - - - -- Type of Tank-- Feet of Drain Tile. - --- — - -_.Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. __- -__ - - -- -Size of Soakage Pit Amount of Permit$ 1 lumbing Inspect The undersigned applicant for this building permit does bareby certify that he understands and accepts his oblige ' s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Penman Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor In y oyed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on . of the wor auc public notice or notices as ere required by the Act The undersigned agrees to employ only such sub - contra ore, on k to ormed under this permit, as are licensed by Miami Shores Village. n o STATE OF FLORIDA, as, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, spun oa 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 serve, and that all facts therein by him stated are true. My Commission Expires Date.______ J.. -. -! No 9 1 VE C Block p- Subdivwon 3 7 T Street_ A/ 9 s Capacity Gels Notary Public, State of Florida NOTE: A re- inspection fee of *1.09 will be made w re4nspeciitin ist made•esscessary by hnproper notico for inspection, or faulty materials and /or workmanship. CLO•ET• BATH TUBS SHOW HIM LAVA• TORIES 6114 SLOP SINKS LAUNDRY Tu•S URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIETURE• a CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR PI EATER DQEP WELL SPRKLR. SYSTEM SW IM'O POOL Co. NTR - LIST CHECK Permit No e-7 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. Owner's Name and Address t jV C 1( L EO\ Registered Architect and /or Engineer y Employing Plumber's Name.../3�.l.Ft~�f✓��L t ( No,. .f. 21. .. m ., „„„ street. .:. /. Location and Legal Description Lot_ 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...- ...__. Repairs No. of Stories Sine Septic Tsnls ._.--------- - - - - -- - - - - -- 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 Amount of Permit$ 1 lumbing Inspect The undersigned applicant for this building permit does bareby certify that he understands and accepts his oblige ' s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Penman Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor In y oyed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on . of the wor auc public notice or notices as ere required by the Act The undersigned agrees to employ only such sub - contra ore, on k to ormed under this permit, as are licensed by Miami Shores Village. n o STATE OF FLORIDA, as, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, spun oa 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 serve, and that all facts therein by him stated are true. My Commission Expires Date.______ J.. -. -! No 9 1 VE C Block p- Subdivwon 3 7 T Street_ A/ 9 s Capacity Gels Notary Public, State of Florida NOTE: A re- inspection fee of *1.09 will be made w re4nspeciitin ist made•esscessary by hnproper notico for inspection, or faulty materials and /or workmanship.