Loading...
797 NE 94 St (13)Permit No Nature of Water Supply: /6 (©7 Amount of Permit STATE OF FLORIDA, I COUNTY OF DADE. ell MIAMI SHORES VILL.:GE PLUMBING INSPECTION DEPARTMENT APPLICATION POR 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 Steven M. Willis No,_g00 Street_ ._ o E ....97th - St o Registered Architect and /or Engineer ____CZ1aT'1 Is s __x�_ Ma rkel Employing Plumber's Name HA N L QN _PLUMBING 00 0 _ No._____ 729___. Street___S.W. 12th Ave. Location and Legal Description Lot_ _______ - 2....... ___ _Block__ 74 Subdivision_ Miami Shores #3 Street and Number where work is to be performed- No._____ 900 __________ Street N.E. 97th Street State work to be performed and purpose of building (By Floors) New Building_ -_ X _-- Remodeling -_.. -- -- Addition _ _ -. Repairs_- -- - -- __. -._ -- -- _ - -- No. of Stories.... Sirs Septic Tank_ Type of Tank Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit ____ ( Signed) car Date _ Capacity Gals. mbing Ins The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio :: s an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe: 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this a ,nit. as licensed by Miami Shores Village. ( Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal!- 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. are are NOTE: A re- inspection fee of $1.O0 will be made when such re- inspection is made•neoessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS a/046h. p,1 d.0 14P TOT FIXTURES CONTR. LIST i f/!. L t —/ CHECK SEPTIC TANK SEWER CONN. �— DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL. SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST — . —_- CHECK Permit No Nature of Water Supply: /6 (©7 Amount of Permit STATE OF FLORIDA, I COUNTY OF DADE. ell MIAMI SHORES VILL.:GE PLUMBING INSPECTION DEPARTMENT APPLICATION POR 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 Steven M. Willis No,_g00 Street_ ._ o E ....97th - St o Registered Architect and /or Engineer ____CZ1aT'1 Is s __x�_ Ma rkel Employing Plumber's Name HA N L QN _PLUMBING 00 0 _ No._____ 729___. Street___S.W. 12th Ave. Location and Legal Description Lot_ _______ - 2....... ___ _Block__ 74 Subdivision_ Miami Shores #3 Street and Number where work is to be performed- No._____ 900 __________ Street N.E. 97th Street State work to be performed and purpose of building (By Floors) New Building_ -_ X _-- Remodeling -_.. -- -- Addition _ _ -. Repairs_- -- - -- __. -._ -- -- _ - -- No. of Stories.... Sirs Septic Tank_ Type of Tank Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit ____ ( Signed) car Date _ Capacity Gals. mbing Ins The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio :: s an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe: 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this a ,nit. as licensed by Miami Shores Village. ( Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal!- 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. are are NOTE: A re- inspection fee of $1.O0 will be made when such re- inspection is made•neoessary by improper notice for inspection, or faulty materials and /or workmanship. A/ PLUMBING INSPECTION CTOON DEPA ( . QPpdOCGQTlOOO CJ GF'JQ PEURA o OCJO PC QMOTj Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith oubmit4 structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Sl�� and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the 1St,.� of Miami Shores Village shall be implied with, whetIter herein Bloodied or nit. A copy of nel.roved plans and specifications must`ve lkept at building during progress of work. Owner's Name and Address "' 09 P ) 0 �L Registered Architect and /or Engineer Employing Plteist 'a Rlaeai@ S SLAT G --7 9fute Bkr.h Street and Number where work is to be performed —No •� y 7 9 4-1" ‘ Sere Location and Legal Description Lot. State work to be performed and purpose of bu tikling ( y l " 1 4 - - - -- New Building -_ -_ -_ _ ---- ...__... -•• -.. Remodeling Addition._.____ _._ (Repairs No. of Stories . . . .......... . . .. Siam Septic Tanis_.._ Type of; MIA Feet of Drain Tile l Feat of 'Tank oa Tama Yield forma Nature of Water Supply: City—Well. Siam el Saokage Pi¢. Amount of Permit a No 7 2 5 9 7_221_ s/. ` ... (Sigsned)_ (/L j to me well known, and who, being by me first duly swam, upm oath slisejs.tms and says that he and of the above described construction, that k h oarafe� t nl tho application, therein by him stated are true. Plu ing 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 5 Compiled General Laws of Florida Pennanent 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 oauaa to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned ass= to employ only such raab- contractors, on work to i� performed annslor this permit, as are lid by Mimi Shwas Village, Master Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a ac ci y public, doily n to administer oaths and take ociutowledgments, personally appeared the ry% and that all facts My Cosnrnissialei Yaryisco Notmy IP�nI c' to ag 1 NOTE: A reinspection fee of 6LC1D vzo l b hp. favpna cWC..) fn3 as au* nee& rials ostd /oa WCChIMMAAP. "" BATH TU00 aPoOWaRO LAVA. TORIaO Guano CLOP LAUNDRY UNORY TUDO URINA!-0 CATCH DAMN FLOOR DRAIN DRINK( Na ROUNT' TOTAL MIATUW[® CONTR. LI OT CMQCtt — _. — _ _. _ S LPTIC Toot 6ar1aR CONN. DRAIN P IQLO DOAKAOa PIT CRQA013 TRAP QOLAR PC QATAR DQQP CjaLL DPPm.o. DTOTaq OwiwID POOL CLIOT LIOT . PLUMBING INSPECTION CTOON DEPA ( . QPpdOCGQTlOOO CJ GF'JQ PEURA o OCJO PC QMOTj Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith oubmit4 structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Sl�� and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the 1St,.� of Miami Shores Village shall be implied with, whetIter herein Bloodied or nit. A copy of nel.roved plans and specifications must`ve lkept at building during progress of work. Owner's Name and Address "' 09 P ) 0 �L Registered Architect and /or Engineer Employing Plteist 'a Rlaeai@ S SLAT G --7 9fute Bkr.h Street and Number where work is to be performed —No •� y 7 9 4-1" ‘ Sere Location and Legal Description Lot. State work to be performed and purpose of bu tikling ( y l " 1 4 - - - -- New Building -_ -_ -_ _ ---- ...__... -•• -.. Remodeling Addition._.____ _._ (Repairs No. of Stories . . . .......... . . .. Siam Septic Tanis_.._ Type of; MIA Feet of Drain Tile l Feat of 'Tank oa Tama Yield forma Nature of Water Supply: City—Well. Siam el Saokage Pi¢. Amount of Permit a No 7 2 5 9 7_221_ s/. ` ... (Sigsned)_ (/L j to me well known, and who, being by me first duly swam, upm oath slisejs.tms and says that he and of the above described construction, that k h oarafe� t nl tho application, therein by him stated are true. Plu ing 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 5 Compiled General Laws of Florida Pennanent 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 oauaa to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned ass= to employ only such raab- contractors, on work to i� performed annslor this permit, as are lid by Mimi Shwas Village, Master Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a ac ci y public, doily n to administer oaths and take ociutowledgments, personally appeared the ry% and that all facts My Cosnrnissialei Yaryisco Notmy IP�nI c' to ag 1 NOTE: A reinspection fee of 6LC1D vzo l b hp. favpna cWC..) fn3 as au* nee& rials ostd /oa WCChIMMAAP. -! GLOM= BATH TIJB O gNOWQRO LAVA• TORIQO SI6"4" SLOP ammo LAUNDRY ruoo URIPoAIa CATCH .AaIPo FLOOR DRAIN DRINKING FOUNT'NO TOTAL RIATURQO CONTR. LIOT -- CHOCK • SEPTIC TANK SQwQR Comm. DRAIN PIQLD SOAKAGE GRQAaI TRAP SOLAR NEATER DEW WELL SPRKLR. SYOTEM SWIM POOL Cop rm. LIOT / 6C7 4,o`, / / 1' I CHECK Permit No. ..L —.7 /( Amount of Permit $ Size Septic Tank_ - -- - -- - = ___...Type of Tank.—_ to me well known, and who, being by me first duly sworn, upon oath of the above described construction, that be has carefully ,read the therein by him , STATE of FLORIDA a URGE !%Y COAwAISStO:`t E:tP :! Ray. :6, 1976 IIONDM Viral GAP EAt I:•I±URAt' t!N'CI sWRtTrrtS My Commission Eupirr s MOA JE SNORES VILLAGE PLUMBING INSPECTION DEPARTMENT AQPPLOCAQ'DOK1 k0G2 PWARM s PERMIT , • Date. _.. /0 /7 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 to made in compliancy 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 scot. A copy of approved plans and specifications must be kept at building during progress of work. �� �� rr Owner' a Name and Address..., /.RJ 4 X o s � _ _ .._. No._Z Street.._lc yr ...n..... 4 < t:: gineer Y ! 2.:/1//V 1 S . c� L D _ Employing Plumber's Nam . . _Nu ‘`" N9.. -8.57-2.:—.."...: tiMeLieZ ,..(6-filf-tiel. _..ti - f: 6 / .. .� _ ! fi' e.S 4 C3 Location and Legal Description Lod — 2-...g.. ffiloc Su�d{vldon � S �4L�; _ ____ Street and Number where work is to be performed — No 7 / Serea4 ....a Q �a.._. .. State work to be performed and purpose of building (By 1i! 6._._. '0 - -• - - �j a / ��Y ..._ ............. - - - -.. New Building ._..- Remodeling_ __ _ ...__ Addition le Repairs No. of Stories Capacity ........... ...... Feet of Drain Tile. - - -- -- _—_Dist. ��Feet of Tank or Drain Field from Well- - -- _ -- y ______.- .•�.• -_ - - -- - - - -- Nature of Water Supply: City — —_� ,�_,e_____ _ -_ - - -- -.Size of Soakage Pit ..X 3. 7 The undersigned applicant for this building permit does hereby certify that he understands and accepts )is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance frdm't tractors or sub - contractors employed by him In the work to be performed under this permit; and will post or cause to be posted' far inspection on = site of the work ch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, work to be . arm u ser this perinit, as are licensed by Miami Shores Village. Plumbing Inspector. STATE OF FLORIDA, t COUNTY OF DADE. Before ry e, the un•ersign authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared P1 Master Plumber. aces and says that �;; is the. - -- -ATE a l u as b E lg. reeding npplicci and, .t Ire did sign the sane, that all facts NOTE: A re- inspection fen of 01.00 will ba made whza soteaspeciftus e'er by issipreper m xicQ fee inspectiaa, materials and/ca worlsmanahip. Permit No 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. �J A A n Owner's Name and Address /I / Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. New Building Remodeling_-_—_. _ ._ Addition STATE OF FLORIDA, i COUNTY OF DADE. IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPLICATION FOR PLUMBING PERMIT — 71locte C Subdivision---------- __ - - -- Street and Number where work is to be performed —No. l 2I F Strom State work to be performed and purpose of building (By Floors) _ ---------- ••-- --- - -- - - - -•— Size Septic Tank< - _.__._.._. _ ..__- - ° --_ — _...Type of Tank__._ Feat of Drain Tile.—.__ — --- — __Dist. Feet of Tank oe Drain Field from Well..._ Nature of Water Supply: of Soakage Pit Repairs No. of Stories Capacity Gala.. ( Signed) — — Amount of Permit $ ( S i g n e d ) - - - " -Gt.e0 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he ul erstands 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 Iles 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 aster Plumber. 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 dpaws and says that he io the.- •--- ......... _.. of the above described construction, that he has carefully sad the foregoing application, and that he did sign the acme, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of IE'la ido NOTE: A re-inspection fee of 0I.00 will ha made at7bn Q I veal= As see a by fmproger nctioa for inspection, or faulky materials and /or erakmanahip. LAUNDRY TUDO ..R IPoALEI CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NO TOTAL FIXTURES CLOSETS BATH TUBE SHOWERS LAVA- TORIES 5I"° SLOP BUNKO CONTR. — LIST CHECK SEPTIC TANK SEWER Comm. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HATER DEEP WELL SPRKLR. SYSTEM SWIM'S POOL ComTA. � I LIST CHECK Permit No 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. �J A A n Owner's Name and Address /I / Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. New Building Remodeling_-_—_. _ ._ Addition STATE OF FLORIDA, i COUNTY OF DADE. IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPLICATION FOR PLUMBING PERMIT — 71locte C Subdivision---------- __ - - -- Street and Number where work is to be performed —No. l 2I F Strom State work to be performed and purpose of building (By Floors) _ ---------- ••-- --- - -- - - - -•— Size Septic Tank< - _.__._.._. _ ..__- - ° --_ — _...Type of Tank__._ Feat of Drain Tile.—.__ — --- — __Dist. Feet of Tank oe Drain Field from Well..._ Nature of Water Supply: of Soakage Pit Repairs No. of Stories Capacity Gala.. ( Signed) — — Amount of Permit $ ( S i g n e d ) - - - " -Gt.e0 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he ul erstands 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 Iles 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 aster Plumber. 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 dpaws and says that he io the.- •--- ......... _.. of the above described construction, that he has carefully sad the foregoing application, and that he did sign the acme, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of IE'la ido NOTE: A re-inspection fee of 0I.00 will ha made at7bn Q I veal= As see a by fmproger nctioa for inspection, or faulky materials and /or erakmanahip. Permit No.....__. —..... '7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub tted 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-74_2_ 1YE Registered Architect and /or Engineer Amount of Permit l STATE OF FLORIDA, 1 COUNTY OF DADE. WHAM SNORES VBL A©E PLUMING INSPECTION DEPARTMENT appLoCAVOON ME PLUMBING PERAAOT (Signed)_ Date... Repairs Subdivision Siva Septic Tank_ of 'Tank —_ Feet of Dram Tile.__ _ ____._ _...Dist. Feet of Tank or Drain Field from Well..... Nature of Water Supply: _____ ---Size of Soakage Pit Employing Plumber's Name j t /. S J.2L N etwLa .../:3J ..S -. 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 Street_ No. of Stories Capacity Gals... _., 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 5888, 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 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 M1amf Shorea Village. I Iaater Plumber. 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 so=o=n, upon oath deposes and says that he is the..-- -_ - - -- - --- --------- - - - - -- -- -----_ _.. of the above described construction, that he has carefully read the ffiooeageing application„ and that he did sign the sa=ne, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of Flexrdda NOTE: A re- inspection fee of 01.00 will be mash wem =el =-kaqatrotiara to by &groper ,Lilco for inspection, or faulty materials and /as workmanship. CLOOirro BATH T00 SHOWQRO LAVA. SIN" SLOP Masao LAUNDRY TUoo URINAL!] CATCH DA01N FLOOR DRAIN DRINKING POUNT•NO TOTAL FIAYURQO CONTR. LIOT CHECK _— - SEPTIC TANK SEWER CONN. DRAIN HELD SOAKAGE PIT GR¢AOQ TRAP SOLAR HEATER MCP WELL SPRKLR. STOMA 9WIM'O POOL CONTR. L I OT CHUCK Permit No.....__. —..... '7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub tted 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-74_2_ 1YE Registered Architect and /or Engineer Amount of Permit l STATE OF FLORIDA, 1 COUNTY OF DADE. WHAM SNORES VBL A©E PLUMING INSPECTION DEPARTMENT appLoCAVOON ME PLUMBING PERAAOT (Signed)_ Date... Repairs Subdivision Siva Septic Tank_ of 'Tank —_ Feet of Dram Tile.__ _ ____._ _...Dist. Feet of Tank or Drain Field from Well..... Nature of Water Supply: _____ ---Size of Soakage Pit Employing Plumber's Name j t /. S J.2L N etwLa .../:3J ..S -. 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 Street_ No. of Stories Capacity Gals... _., 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 5888, 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 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 M1amf Shorea Village. I Iaater Plumber. 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 so=o=n, upon oath deposes and says that he is the..-- -_ - - -- - --- --------- - - - - -- -- -----_ _.. of the above described construction, that he has carefully read the ffiooeageing application„ and that he did sign the sa=ne, and that all facts therein by hire stated are true. My Commission Expires Notary Public, State of Flexrdda NOTE: A re- inspection fee of 01.00 will be mash wem =el =-kaqatrotiara to by &groper ,Lilco for inspection, or faulty materials and /as workmanship.