PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
C ,L 10.2.7:-. G(�,'
Dater. �3 /O' / Job Address 4 �Q Q7" - A Tax Folio
Legal Description
Owner/Lessee / Tenant /v J/LL /4 L, 2 / Master Permit # ( 2-3 72._
Owner's Address ¥ l y N• E 9Z/ 7V 3r Phone 737 — ,7l0
Contracting co. LL o) 3 P7 Address A). IA L- ///11.57: *JAW/
Qualifier
TE RESA J- F Elm. SS# Phone 1 5! — 16 1 6
State # 1/45E q 017 -k Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMB MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION t fj1 A 4.l 012.A-4 N F1 W
Square Ft. boo
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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
of owner or • do P
/1
Date
Notary as to
My Commission Expires:
LESTER E. CROCKETT
My Comm Exp. 5/20/2001
Boncled By Service Ins
No. CC649326
I 1 Personally Known I 1 Other I.D
FEES: PERMIT 3' RADON
3
Date
APPROVED:
Zoning Building
Mechanical Plumbing
ef/
C.C.F. / NOTARY
Historically Designated: Yes No
Competency # Ins. Co.
Address
Address
Estimated Cost (value) 1 s O b. DO
Notary as to Contra • or
My Commission Expires:
LESTER E. CROCKETT
My Comm Exp. 5/20/2001
Bonded By Service Ins
No. CC649326
f I Personally Known 11 Other I.D
Electrical
Engineering
BOND --S o a
3--//4
Date
TOTAL DUE 3 9',
zO
APPLICANT: L <9C T
0
T
H
E
R
APPROVED BY:
DATE ISSUED: 41
STATE OF FLORIDA PERMIT # q" ° ® 1 C I
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID "__
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT # 3 4 Z - e - )
Authority: Chapter 381, FS & Chapter 10D -6, FAC
CONSTRUCTION PERMIT FOR: � _ / S
[/ New System [Existing System [ �/nolding Tank [ r° ) Temporary /Experimental
[•j) Repair [ ] Abandonment [ ] Other(Specify)
PROPERTY STREET ADDRESS: " -' €7 4
LOT: .J BLOCK: ,4/ .. SUBDIVISION: N
PROPERTY ID #: //- 3 ao‘,- Q / Ie � 4 7 0[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
'�` [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DES I.G Np S F;CATIONS
T [ ¶ I C I V 1 ALLONS / GPD] PTIC TAN EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS N / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ rs' S DARE FE DRAINFIELD SYSTEM
R [ ] SQUARE'FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ `1 BED [ 1
N `�
F LOCATION OF BENCHMARK: F t 4E /0.7 91.2
I ELEVATION OF PROPOSED SYSTEM SITE [ ) a- ] 5. [ABOVE BENCHMARK FRF* *rte nr
E BOTTOM OF DRAINFIELD TO BE [ `� ]NQES/.'T] [ABOVBELOhJBENCHMA REFERENCE POINT
L i _
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 30 ] INCHES
/7
SPECIFICATIONS BY: TITLE:
HRS -H Form 4016, Mar 92 (0bsoletes previous editions which may not be used)
(Stock Number: 5744- 001- 4016 -0)
APPLICANT
AGENT:
TITLE: /2 6./ CpHU
EXPIRATION DATE:
Page 1 of 2
CONSTRUCTION PERMIT FOR:
[ /"] New System [/V / Existing System
[Ot] Repair [Abandonment
PPLICANT: J f , ,
' L.
PROPERTY STREET ADDRESS: i /, ,
LOT: f � A BLOCK: /i .\ SUBDIVISION: „)
PROPERTY ID #: f/ ✓ ao � ' ` U r! C O [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
k� 't / [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE, FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIWAND SPECIFICATIONS
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: /i s/ e y d /
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
a
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may bot be used)
(Stock Number: 5744- 001 - 4016 -0)
ti[LDING DEPARTMENT
2•
50.
V- 3
J 2
/ d •
[/ Molding Tank [�] Temporary /Experimental
[ Other(Specify)
AGENT: f / t
EXPIRATION DATE:
T [ 7c] (�G�ALLONS / GPD] EPTIC TANK AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GAL'tJN / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ G ae.J ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND ( ]
I CONFIGURATION: [ ] TRENCH [ -] BED [ ]
N _ r
F LOCATION OF BENCHMARK: F t. £ / rr ..f �» _
I ELEVATION OF PROPOSED SYSTEM SITE [ /a ] CHES,/,FT] [ABOVE LOW ENCHMARK EFE ,]dC'R PnT
E BOTTOM OF DRAINFIELD TO BE [ KLINCHE,S [ABOVV�_`EL ,BENCHMARI(REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: ( 3e) ] INCHES
TITLy;
TITLE: / CPHU
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
%p:
APPLICANT: L.NCF1
LOT: 0L BLOCK: 0 SUBDIVISION: t
PROPERTY ID #: [Section /Township /Range /Parcel No. or Tax ID Number]
�p WE C I L IC ST d
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S M[T
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH
SURFACE WATER: 10) FT
WELLS: PUBLIC: 100 FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES Y] NO 10 YEAR FLOODING? [ ] YES 10 NO
10 YEAR FLOOD ELEVATION FOR SITE: %NJ . FTIENNGVD SITE ELEVATION: ct 7 FT /NOVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
N A
Munsell # /Color Texture Depth
o U) 01 0 to
to
to
to
to
to
to
to
to
USDA SOIL. SERIES:
OBSERVED WATER TABLE: ' INCHES [ABOVE
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ]` YES [,(] NO
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: e. INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [,'] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BII:
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: :OA FT NORMALLY WET? [ ] YES tea'] NO
LIMITED USE: INA FT PRIVATE: N 4N FT NON- POTABLE: FT
55 FT PROPERTY LINES: FT POTABLE WATER LINES: e FT
"t"
HRS -H Form 4015, Mar 92 '•sole -s previous d i ions whi h may not be used)
(Stock Number: 5744 - 003 -40 1)
AGENT: LLO \f D - o 127 4 0 ADE
isell # /Color Texture
‘15e_cw 1 Piss
USDA SOIL SERIES: 7
PERMIT # 9
DATE:
[ ] YES T(] NO NET USABLE AREA AVAILABLE: S2 ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
‘2..„ [ CH /FT] [ABOVE/EL1] BENCHMARK /RED POINT
Depth
-O to 2
to
to
to
to
to
to
to
EXISTING GRADE. TYPE: [PERCHED / APAREN]
INCHES [ ABOVE / 4 ] EXISTING GRADE.
MOTTLING: [ ] YES [O NO DEPTH: tin INCHES
Page 3 of 3
INSTRUCTIONS:
FERMI.' §': Fearni: tracking numbs. :: :;cir;n d
APPI -ICINi ': Property ow.ner'u full :tan!e.
AGENT: ?rope: >y ow er's loyally au:i!ar::es taaiprsa:__id:tive.
CC a :'.7 .VLSiO;': °,c:'., subdivtriton lot.
FROPERI'Y ;i ' : 2i c r.at::r member fr. ? 3 - (pay lay ap r.aicsr it o L^.cticn /township /range /parcel number)
PROPERTY 21 %E: Chet:; if property eiz ,it sitc cut :brim:; t0 suorni'ted cite plan. iieco!d rot us ble area available -'o' area exclusive of
•.li paved arcza and pn i - cc ra>.•r. `t:d,e within public. rights-of-way ea eacementis and exclusive of sl:aa>ns, lakes,
n: wet drainage ditch ,, :!r :lain;, mina: Bach bodices of suet& :_.
SEWAGE FLOW:
UNOBSTRUCTED ,?It`U.A:
'Record sac estimated sewage !or-a for the establishment frc:at iabie i (residences) or "able. 2 (non - residential), Chapter
00_ fr, AC. '? Record ti r=: L oaizaci aawaga flow fa:• ale Ict i;a boot on net usable area and wait.; Supply (1500 gallons
pe_ pry ,c. sera: for p.ivate .v t,;::asap lieu and 2500 apc per Acta: for public water supplies). ITauthorizcd sewage flow
dcec not ...Waal or c, cecd Lhc ,, ^.cti x ;_rr r:f:Wv i7,t: ??ow, the application mutt be denied.
stern::: the aquare feet cf unan:a :,acicn axe available. and the amount rcquircc. Unobstructed area must be at least 2
roes as 1. :mgr as the d.uintield ehaerotion area and at leers_ 75 perceni of the unobstructed area must meet minimum
sctba. ks La Chapter 10D -6, '- !c unobstructed area must be contiguous to the drainfield.
BENCHMARK 1NFOR'.SA T ION: Record the location of the oenchrizr_ :. H' using a surveyor's bcnchmairk record the actual elevation. Record the
.:t. nation of the proposed :,ys.urn :,i :e in relation (above o: below) to the benchmark.
MINIMUM SETBACKS:
laveord minimum setback which can be meet to all dated features. Actual measurements must be recorded or "NA"
for non applicable featur_r. ;?: :c :u_r; oa site ylan or within. 75 feet of the applicant lot must he measured. The location
of any public drinking wail within 200 feet of he applicant's lot must also be. verified.
FLOOD INFORMAL :3N: : :cord information on Ict's auojcct to hooding. For lots subject to flooding record 10 year flood elevation for site and
actual site elevation.
SOiL PROFILE IN' ;O`.t tATiON: '''wo soil prof within the p_oposeri ahaoratio,, arca to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology 0. :unwell colors and USDA soil textures). Refusals must
be clearly do. uidented. '';ov,ce JSDA L eeriest if available, r,cord "UNK' if the iseriea cannot be determined.
WATER TABLE: ice.ord the depth of the ohaer.eu water table at the time of the evaluation. ?Sark "perched" or "apparent" as
anpronriate. Record the ea :irn :..t:;c: v. at aezeon water table elt.vr:tion d led on site evaluation, JS)A soil maps, and
1 niteaivai information. ens icr.va i`there is high wrujs'a.b!e Yd ± ;eiaiiun ?resent. .indicate if mottling is present and depth.
SOiL. TEXTURE: . t. curd soil texture or loading in:a, for aystet-r sL ira;
DEPTH CF EXCAVATION: If applicable record depth o_'c; aavatior re uiaed. _ ccoad " ::'A" if not app :let:We.
DRAINFIEL CONF.CURA'. iCN: :2bec a rrainfiald aonfigurrtios: - ;ga.lire . If o:hcr, specify type.
ADDITIONAL. CRITERIA: aReeo:d any additional remarka pe:tin,:nt to alto or installation. Ea. dosing required.
SITE EVALUATE) BY: Sigustuiv of evaluator, title, rant; data: of evaluation. Professional engiaecrs must seal all documentation submitted.
ELEVATION WORKSHEET l vA"f;ON OF BENCH J A2 a / alaFERENCE a.,'dN ; "s5:
BENCHMARK SITE i SITE 2 SITE 3
( +) SHOT: H.I. H.I. H.I.
H.1. f -1 SHOT [-] SHOT f -( SHOT
APPLICATION FOR:
[w� ] New System
,[1] Repair
APPLICANT:
.. 0 "jil- NSOQ -r
MAILING ADDRESS:
AGENT:
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT:
PROPERTY ID #: q _q c [Section /Township /Range /Parcel No.] ZONING:
PROPERTY SIZE: ACRES [Sgft /43 60]
PROPERTY STREET ADDRESS: ^+ n L1/2-
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [X] RESIDENTIAL
Unit Type of
No Establishment
1
2
3.
4
N
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
[ ] Existing System
W Abandonment
BLOCK: SUBDIVISION:
Ni
] Garbage Grinders /Disposals
4,1] Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE: ,Vt2P;G
,
No. of
Bedrooms
N
DR µ -
HRS -N Form 4015, Mar 92 (Obsoletes previous eddi ions which may not be used)
(Stock Number: 5744 - 001-4015 -1)
[
] COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[NI] Holding Tank W] Temporary /Experimental
[P Other(Specify)
TELEPHONE: 7 g
DATE OF LiC
SUBDIVISION:
Building # Persons Business Activity
Area Sgft Served For Commercial Only
DATE: I
K14-
PROPERTY WATER SUPPLY: [ ] PRIVATE y ] PUBLIC
Spas /Hot Tubs k.] Floor /Equipment Drains
Other (Specify)
Page 1 of 3
INSTRUCTIONS:
APPLICANT: ovi.
.r r ■ - .3..0: 7 1 7 '.:.*::: - . 7 .' - 7;•("V"_7 7 .!C:'). 7.'7C" 7T:CC;:Tcr co,?y
, 777 r - ; 7; :lyt . '''.
- • .,: ;
• . , :7' .:/:;7'
_ v • 1
viny :. •
• 0:
Sr i .1: '•or ni.1 CC road crid locale ir county.
liiit to lot Cr et lot:Frio:1
or commercial.
ty2,: 'ilor: '7 t' 17:711;y, i.inr!e wide mobile reriz.vrant,
do, tor's
NO. fil - itle ;•leci accommodations fa:
occupants.
-'c ht i•torrzr rlic;d, o operi or
on C11 of
# LI': ;.i 71 10
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Site Plan Submitted by
Plan Approved
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION PLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002- 4015 -6)
PART II - SITE PLAN
•
SIGNATURE
By
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
I _ I _ I _ '
4J
1-
L •
+ ' I
11
TITLE
1 Not Approved Date.' "
County Public Unit
Page 2 of 3
Permit No
Owner's Name and Address__
Registered Architect and /or E
Employing Plmeber's Name
Feet of Drain Tile_3
Amount of Permit $
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.
ngineer - — - - - —
14 0 _&MC
State work to be performed and purpose of building (By Floors)
.___._--- _ - -_ --
New Building - _._ Remodeling____ - _._____ Addition.
( Signed) _
Date
Ikea_ _a 6/66
No.____ -_ ` 4 _l4 N'C• street - - -_ 9r 4 *
J/
• No._ j 97 ' Street__1_S! - ( 1' 1 ' ST: .......
-
Block___— - . Subdivision
Location and Legal Description Lot. ' ` Ake" e _ L
Street and Number where work is to be performed -No `f i q ' Street_-•9 T ST
Repairs No. of Stories.
Size Septic Tank - Type of Tank___ Capacity Gals
& �/�
cDist Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well .__ — ____Size of Soakage Pit
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen pplement, 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.
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 hixr 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
S
SLOP
SINKS
LAUNDRY
TUBE
URINALS
RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE6
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FI ELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
-
CONTR.
LIST
-
CHECK
Permit No
Owner's Name and Address__
Registered Architect and /or E
Employing Plmeber's Name
Feet of Drain Tile_3
Amount of Permit $
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.
ngineer - — - - - —
14 0 _&MC
State work to be performed and purpose of building (By Floors)
.___._--- _ - -_ --
New Building - _._ Remodeling____ - _._____ Addition.
( Signed) _
Date
Ikea_ _a 6/66
No.____ -_ ` 4 _l4 N'C• street - - -_ 9r 4 *
J/
• No._ j 97 ' Street__1_S! - ( 1' 1 ' ST: .......
-
Block___— - . Subdivision
Location and Legal Description Lot. ' ` Ake" e _ L
Street and Number where work is to be performed -No `f i q ' Street_-•9 T ST
Repairs No. of Stories.
Size Septic Tank - Type of Tank___ Capacity Gals
& �/�
cDist Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well .__ — ____Size of Soakage Pit
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen pplement, 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.
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 hixr 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/ _ 5i1
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 hores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein s•ecified •/ ot. 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
`yCri
Feet of Drain Tile
Amount of Permit $
o D
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
Date
Location and Legal Description Lot Block Subdivision
Street and Number where wo is to be performed —No /. p " g , 9 1 - - Street
State work to be perform and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank (.... -'
Capacity Gals
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 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 loyed by hint in the work to be
performed under this permit; and will post or cause to be posted for inspection on the otice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contracto his permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
aster Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DARE.
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
CONTR.
LIST
CHECK
J_
Permit No/ _ 5i1
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 hores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein s•ecified •/ ot. 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
`yCri
Feet of Drain Tile
Amount of Permit $
o D
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
Date
Location and Legal Description Lot Block Subdivision
Street and Number where wo is to be performed —No /. p " g , 9 1 - - Street
State work to be perform and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank (.... -'
Capacity Gals
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 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 loyed by hint in the work to be
performed under this permit; and will post or cause to be posted for inspection on the otice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contracto his permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
aster Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DARE.
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 /: /1
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
Registered Architect and /or Engi
Employing Plumber's Name__
Location and Legal Description Lot,/_o�_¢ _La/
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
Streeb�_c1E /_�_/
Block A Subdivision
. Street / _F•
Remodeling Addition
yy ��-
e. 174. '.,,, 1 2, 7 _ 1.91
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: /it) -Well _ Size of Soakage Pit
(Signed)
( Signed) __e
No T20/ Street_ a"
Date ___'__�i
Repairs No. of Stories 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 undersigned 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, 1 ss.
COUNTY OF DADE. 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
S INKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
D / `f
w�u dt�
f ! �
0 �:.
4.1 (3 1
TOTAL
FIXTURES
i/
CL
ST
L
OOCC
2
CK RI
i
/
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 /: /1
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
Registered Architect and /or Engi
Employing Plumber's Name__
Location and Legal Description Lot,/_o�_¢ _La/
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
Streeb�_c1E /_�_/
Block A Subdivision
. Street / _F•
Remodeling Addition
yy ��-
e. 174. '.,,, 1 2, 7 _ 1.91
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: /it) -Well _ Size of Soakage Pit
(Signed)
( Signed) __e
No T20/ Street_ a"
Date ___'__�i
Repairs No. of Stories 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 undersigned 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, 1 ss.
COUNTY OF DADE. 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
w• .
Pis
rviIR
--? ,0 pity/
Owner of
Building
_ -r-
Bob&
vision
, F'
Value of I Amt. of
Project .Perish ' l
raat the budding or to install the aer device
the vaderstandbg due the work be is
by the paver mupsl a o This Pti
withal* atathetitiatiost. A
isit a of gm
la speeificatieas be
,8
I
0 ,
Architect
Oontractor
or Builder
Legol lot
ressairdie*
-
Address of
Building
to
The
hereka la &toot
(i tZett.
graotad le the
P
dm* In Do
Baba
davit
Value d
Prated
t
Permit No. .X/1.7/9
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications her submi ed for the building or other
structure herein described. This application is made In compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of. Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept et
building during progress of work
Owner's Name and Addr
Registered Architect and/or Engin
EiploYin$ Plumbges e
// . tion an / d Legal # p on LotAt / 5 Mork 5 subden._74
Street and Number where work is to be performed—No / 9 N 9 V , c't
State work to be performed and purpose of building (By Floors)._
New Building. Remodeling Addition.
Size Septic Tank__
Feet of Drain Tile.-?
Nature of Water Supply: City—Well.
My Commission Expires
_Type of Tank__
Feet of Tank or Drain Field from Well .
Size of Soakage Pit
Amount of Permit $ xi5
Repairs No. of Stories ......
Date._
(si
(Signed)
/U2_
s
Plumbing In ipec tor.
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 hay com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wor '. to
performed under this permit; and will post or cause to be posted' for inspection on the site of work such public notice or notices as arr
p
required by the Act The undersigned agrees to employ only such sub-contractors, be performed 9dfr permit,
licensed by Miami Shores Village.
Notary Public, State of Florida
STATE OF FLORIDA, t is.
COUNTY OF DADE. I
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 be has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-Inspection fee of 0.00 will be mods whom nob rolowoodos M map. soossouy by wroper moth* for baspection, of faulty
materials sad/or wcel000nship•
CLOUTS
OATH
TU•11
""cali
LAVA.
'roams
SINKS
SLOP
SINKS
L.AUNOAY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
.....
SEPTIC
TANK
SERER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
Srmicut.
SYSTEM
!Ph 114'0
POOL
_
C *arm
LIST
CHECK
Permit No. .X/1.7/9
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 her submi ed 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 et
building during progress of work
Owner's Name and Addr
Registered Architect and/or Engin
EiploYin$ Plumbges e
// . tion an / d Legal # p on LotAt / 5 Mork 5 subden._74
Street and Number where work is to be performed—No / 9 N 9 V , c't
State work to be performed and purpose of building (By Floors)._
New Building. Remodeling Addition.
Size Septic Tank__
Feet of Drain Tile.-?
Nature of Water Supply: City—Well.
My Commission Expires
_Type of Tank__
Feet of Tank or Drain Field from Well .
Size of Soakage Pit
Amount of Permit $ xi5
Repairs No. of Stories ......
Date._
(si
(Signed)
/U2_
s
Plumbing In ipec tor.
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 hay com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wor '. to
performed under this permit; and will post or cause to be posted' for inspection on the site of work such public notice or notices as arr
p
required by the Act The undersigned agrees to employ only such sub-contractors, be performed 9dfr permit,
licensed by Miami Shores Village.
Notary Public, State of Florida
STATE OF FLORIDA, t is.
COUNTY OF DADE. I
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 be has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-Inspection fee of 0.00 will be mods whom nob rolowoodos M map. soossouy by wroper moth* for baspection, of faulty
materials sad/or wcel000nship•
MIAMI SHO.RES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
qq 95 . � i h4 A v
Permit No..._...._-_ l ._..- __ - -.- `�
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.
1 6wnet s Name and Address kA-J 1 1 10V-1 Z 14-e Et-
Registered Architect and /or Engineer
t.- Em login Pl tu� s N e 0 w ^' O'
� idoJtion and Legal Description Lot : A+ 1gkK� _ Subdivision • "di 2
Street and Number where work is to be performed -No L) 1 9 /
Amount of Permit $ "K
(Signed)-
(Signed
rr
Not /
Street A% E' 5 V 47
Street/kJ E. 9 Y s T.
M ate work to be performed and purpose of building (By Floors) — D_& g g7Za New Building. ...._ Remodeling----. ______ Addition. _. _ -.. Repair No. of Stories
Size Septic Tank- ...Type of Tank__.
Feet of Drain Tile Die* 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 5988, 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 he
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 arc
required by the Act. The undersigned agrees to employ only such sub - contractor, 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 mods whoa snob sa•hspsottoa Y snada snoas-ary by improper notion for lbaapectio , or faulty
materials and /or workmanship.
CLOSETS
OATH
7USS
""g"
RYA
TORIES
SINKS
SLOP
SINKS
LAUNDR
TUG[
URINALS
CATCH
S ASIN
FLOOR
DR AIN
DRINKING
FOUNT'NS
TOTAL
FUTURES
CONTR.
LIST
CHECK
—
SEPTIC
TANK
St MIX
CONN.
DRAIN
FIaLD
SOAKAGE
PIT
G
TRAP
SOLAR
MATER
Dasr
WELL
a
SYSTEM
SWIM'G
POOL
CowrR.
LIST
CHECK
MIAMI SHO.RES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
qq 95 . � i h4 A v
Permit No..._...._-_ l ._..- __ - -.- `�
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.
1 6wnet s Name and Address kA-J 1 1 10V-1 Z 14-e Et-
Registered Architect and /or Engineer
t.- Em login Pl tu� s N e 0 w ^' O'
� idoJtion and Legal Description Lot : A+ 1gkK� _ Subdivision • "di 2
Street and Number where work is to be performed -No L) 1 9 /
Amount of Permit $ "K
(Signed)-
(Signed
rr
Not /
Street A% E' 5 V 47
Street/kJ E. 9 Y s T.
M ate work to be performed and purpose of building (By Floors) — D_& g g7Za New Building. ...._ Remodeling----. ______ Addition. _. _ -.. Repair No. of Stories
Size Septic Tank- ...Type of Tank__.
Feet of Drain Tile Die* 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 5988, 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 he
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 arc
required by the Act. The undersigned agrees to employ only such sub - contractor, 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 mods whoa snob sa•hspsottoa Y snada snoas-ary by improper notion for lbaapectio , or faulty
materials and /or workmanship.