905 NE 95 St (9)Penns, Nu. ce ....._____ Date..
:,eple.,tl, n 1. hereby mode for the approval of the detailed statement of the plans and specifications herewith guile .• .d for the building or other
- tructure herein described. This application in made in compliance and conformity with the Building Ordinance of Poi. ! Shores Village, Florida,
4,:d all pros i.ions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic. • of the Building Division
re Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept at
•)uilding during progress of work.
at4i-- )4 o
' Name and Address
.egist Bred Architect and /or Engineer �p� 7-7//7.1 — C, ,
:mploying Plumber's Name lY' ��� r. ",,' <!G
Location and Legal Description Lot_ ' Bloch Subdivision__..._.
Street and Number where work is to be performed —No 40,5 /U / 9
Street
State work to be performed and purpose of building (By Floats) _ . ife . -. - -. 7?} ........... 7!1' IC 40-4_
New Building ..... .- ..... Remodeling—__ Addition Repairs Nc of Stones
CONTR
LI T
CMaCK
COWTT
LIOT
CHacK
CLOa¢Ta
SEPTIC
TANK
Size Septic Tank_
BATH
Tue0
SEWER
CONN.
Amount of Permit $ L
STATE OF FLORIDA, b
as.
COUNTY OF DADE.
SHOWERO
DRAIN
POLO
LAVA•
TORIu0
SOAKAGE
PIT
My Conunission Erpirea
MO&MO SHORES JODUAG
PLUMBING INSPECTION DEPARTMENT
QG PLICQTOOOM FOR OadUMBHO P(iRMOT
SINKO
GREAaa
TRAP
SLOP
HINK0
SOLAR
HEATER
LAUNDR
Tuoo
Damp
WALL
Feet of Drain Tile. 3.1` — ._.____Dist. Feat of Tank or Drain Field from Well
Nature of Water Supply: City — Well..______ _._._ ..... of Soakage Pit
(Signed
( Sigma
)
UrNALO
BPRKLR.
SYGTQG
Stre2t_...7Y J � 1� s /A •-
CATCH
BAOIN
awits.e
POOL
FLOOR I DRINKING
DRAIN ROUNT'NO
__ -- ..Type of Tank_ - Capacity , ,,ala e ;f -
Plumbing Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n,tloyei of !Dike
under the Florida WVorkrnen's Compensation Act, being Section 54388, Compiled General Laws of Florida Permanent upi lenient, and has , . - w-r
i . d with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in ' e • . rk v
eerierrned under this permit; and will post or cause to be posted for inspection on the site of the wo uch pslhl' notice r. no ice- Is a.-
required by the Act. The undersigned agrees to employ only such sub - contractors, an work .< ,erfonned to this
Licensed by Miami Shores Village.
- Mast a Plumber
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take pzrwT.a: ; , ppear!et.
to me well known, and who, being by me first duly sworn, upon oath depoaas and says that he is the . .
of the above desuibed construction, that he has carefully rend the foregoing applicattor', and that he did sign the same, and tnat all acts,
therein by his, stated are true.
Notary Public, State of Floaido
TOT..L
RIAT. Rao
NOTE: A re inspection fee of 01.00 will ba ma& whsz cads rya to 5rr2&' ry by improper nation for inaps•-eon, to toutt)
materials and/ca workmanship