440 NE 94 St (17)Permit No
Location and Legal Description Lot-_—.._- -- - - - - --
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application i • hereby made for the approval of the detailed 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 Div lion
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 Engineer
Employing Plumber's Name ___ ___ _._.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors). - _
New Building
Size Septic Tank._ _ ._ __ ._ -
Feet of Drain Tile____. -_ -_ . -- _ 3?_ _ -- __ _ _Dist. Feet of Tank or Drain Field from Well..
Nature of Water Supply. City—Well. ___ _ _ - - _- - . Si of Soakage Pit
Amount of Permit $ _- .
STATE OF FLORIDA,
COUNTY OF DADE. j
8/26/69 -- —
Date __ -- -- -_ —. ._
Y. _Lieth, No._ 490__--- N•E•__ Street.- - _ 94th Street
0_ e_al Septic `yank Co.
O t4ealstic _ 'lank Co No . 8350 N.W. Street. 5 6_ Street -
__e__p
— —_— Block_-. _ Subdivision_ ._ _ -__ --
490 N. E street- . _ 94th _ Street
Poles& x 6 . 7 f ' n) / /y rn) ,Si c.d
Remodeling— _ -- _- _ . _ _ Addition____ _ _ _. ____ __. _ Repairs_ g: _. _. No. of Stories .
3, 00 _ ( Signed) _ .L.
__ _Capacity Gals.
Pkmb•ng In:pecto.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o _ ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pe.' : ent Supplement, "nil I as om •
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo. _ ed under this per nit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgn ents, 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 -
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
TUBE
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU.T'NB
TOTAL
F %TURES
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
Location and Legal Description Lot-_—.._- -- - - - - --
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application i • hereby made for the approval of the detailed 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 Div lion
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 Engineer
Employing Plumber's Name ___ ___ _._.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors). - _
New Building
Size Septic Tank._ _ ._ __ ._ -
Feet of Drain Tile____. -_ -_ . -- _ 3?_ _ -- __ _ _Dist. Feet of Tank or Drain Field from Well..
Nature of Water Supply. City—Well. ___ _ _ - - _- - . Si of Soakage Pit
Amount of Permit $ _- .
STATE OF FLORIDA,
COUNTY OF DADE. j
8/26/69 -- —
Date __ -- -- -_ —. ._
Y. _Lieth, No._ 490__--- N•E•__ Street.- - _ 94th Street
0_ e_al Septic `yank Co.
O t4ealstic _ 'lank Co No . 8350 N.W. Street. 5 6_ Street -
__e__p
— —_— Block_-. _ Subdivision_ ._ _ -__ --
490 N. E street- . _ 94th _ Street
Poles& x 6 . 7 f ' n) / /y rn) ,Si c.d
Remodeling— _ -- _- _ . _ _ Addition____ _ _ _. ____ __. _ Repairs_ g: _. _. No. of Stories .
3, 00 _ ( Signed) _ .L.
__ _Capacity Gals.
Pkmb•ng In:pecto.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o _ ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pe.' : ent Supplement, "nil I as om •
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo. _ ed under this per nit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgn ents, 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 -
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.