780 NE 94 St (8)Permit No. ..� 7 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
Registered Architect and /or Engineer..-.-__..—
Employing Plumber's Name
Location and Legal Description,
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
I. B ,
7,17 - 0 9 Y
No. Street.
- - - - - -- Street.___ ..... _._- •--- . . .... _...._
� Subdivisio ..._- _..____� ..___._ _....
7c ; street - - - - -- _ _................ - . .....
...
State work to be perfonne8 and purpose of building (By Floors).___ — _ _ _ _ Y
i g. . Remodeling ._ __ Addition----- ___.- ._ - - - -. Repairs No. of Stories
Size Septic Tank_._ -__ —.
--------- _ -__ -- -.Type of Tank_._
Feat of Drain Tile._. ___._L ®..---..__._.Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply (City - Well.._ , __ .... . -.Size of Soakage Pit
Amount of Permit $
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 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. (9,S®
/ 6 . (Signed).
Master Plumber.
STATE OF FLORIDA, I ss.
COUNTY OF DADE.
Befare me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
(Signed)-
Capacity Gals.
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 foregadng 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 re- inspection fee of 1)1.00 will be made when such re-inspection is made 'necessary by improper notice for inspection, or faulty
materials /or worlananship.
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Permit No. ..� 7 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
Registered Architect and /or Engineer..-.-__..—
Employing Plumber's Name
Location and Legal Description,
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
I. B ,
7,17 - 0 9 Y
No. Street.
- - - - - -- Street.___ ..... _._- •--- . . .... _...._
� Subdivisio ..._- _..____� ..___._ _....
7c ; street - - - - -- _ _................ - . .....
...
State work to be perfonne8 and purpose of building (By Floors).___ — _ _ _ _ Y
i g. . Remodeling ._ __ Addition----- ___.- ._ - - - -. Repairs No. of Stories
Size Septic Tank_._ -__ —.
--------- _ -__ -- -.Type of Tank_._
Feat of Drain Tile._. ___._L ®..---..__._.Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply (City - Well.._ , __ .... . -.Size of Soakage Pit
Amount of Permit $
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 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. (9,S®
/ 6 . (Signed).
Master Plumber.
STATE OF FLORIDA, I ss.
COUNTY OF DADE.
Befare me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
(Signed)-
Capacity Gals.
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 foregadng 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 re- inspection fee of 1)1.00 will be made when such re-inspection is made 'necessary by improper notice for inspection, or faulty
materials /or worlananship.
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