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10766Street Number where work is to be performed —No STATE OF FLORIDA, COUNTY OF DADE. My Commission expires 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 thejState of Florida, all ordinances of Miami Shores Village: and all rules and regulations of the Building Division of Miami Shores Village shall be corplied with, whether herein specified or not. A copy of .approved p and specifications must bekept at building during progress of work. �' . Owner's Name and Address VARA/Fit ]Registered Architect and /or Engineer Capacity Gals k ®. Size Septic Tank Type of Tan Feet of Drain Tile isr - — - - s - Feet of Tank or Drain Field from Well Nature of. Water Supply: City —Well. Size of Soakage Pit -.. Amount of Permit $_ y (Signed) (Signed) Employing Plumber's Name "A��a e e t 5t`Ae f 1No. 1 Stzeet -� "; Location and Legal Description Lot, Block Su • • on_______; 'Z:5 VS. _. r State work to be performed and purpose of building (By Floors) Re41% y 0 44 )01/,'Fdt ID- Tlelnodehn Addition Repairs "' No. of Stories 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 hint 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. Notary Public, State of Florida Before me, the undersigned authO rity, a notary public, duly authorized to administer oaths an take acknowledgments, personally appeared to me well known, and who, being by ine 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 $1.00 wild be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUB$ _ iii SHOWER LAVA. TORIES SINK SLOP • SINKS LAUNDRY TUBS URINALS C ATASICH N -- . B 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 SWIM'0 POOL - CONTR. LIST '. CHECK Street Number where work is to be performed —No STATE OF FLORIDA, COUNTY OF DADE. My Commission expires 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 thejState of Florida, all ordinances of Miami Shores Village: and all rules and regulations of the Building Division of Miami Shores Village shall be corplied with, whether herein specified or not. A copy of .approved p and specifications must bekept at building during progress of work. �' . Owner's Name and Address VARA/Fit ]Registered Architect and /or Engineer Capacity Gals k ®. Size Septic Tank Type of Tan Feet of Drain Tile isr - — - - s - Feet of Tank or Drain Field from Well Nature of. Water Supply: City —Well. Size of Soakage Pit -.. Amount of Permit $_ y (Signed) (Signed) Employing Plumber's Name "A��a e e t 5t`Ae f 1No. 1 Stzeet -� "; Location and Legal Description Lot, Block Su • • on_______; 'Z:5 VS. _. r State work to be performed and purpose of building (By Floors) Re41% y 0 44 )01/,'Fdt ID- Tlelnodehn Addition Repairs "' No. of Stories 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 hint 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. Notary Public, State of Florida Before me, the undersigned authO rity, a notary public, duly authorized to administer oaths an take acknowledgments, personally appeared to me well known, and who, being by ine 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 wild be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. REQUEST FOR INSPECTIO Company, Job A.M. P.M.