PLUMBINGr
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ _ 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 ., , • a 'c __1____ - No Street
Registered Architect and /or Engineer
Employing Plumber's Name . :_____ /___ _% No Street__
Location and Legal Description Lot___�� 11 , _ __— rc� __ Block__ / Subdivision
Street and Number where work is to be performed —No )___, S treet____.___ __
State work tome performed and purpose of building (By Floors)
B uilding
Remodeling Addition Repairs No. of Stories
-"'`--.. 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
matetials and /or workmanship.
Size c Se ti Tank Type .
p • T e of Tank_____ _— -____ ____ � � Capacity Gals •
Feet of Drain Tile LF 9 — _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well / — Size of Soakage Pit
Amount of Permit $ - /__.�" :
ss.
(Signed)
(Signed)
My Commission Expires Notary Public, State of Florida
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 5966, 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.
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
: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 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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT •NS
TOTAL
FIXTURES
CONTR.
LIST
��
G
G ''
V
/ -.
^
LAI�
L'
C
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SCRR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
f
vc5
CHECK
r
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ _ 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 ., , • a 'c __1____ - No Street
Registered Architect and /or Engineer
Employing Plumber's Name . :_____ /___ _% No Street__
Location and Legal Description Lot___�� 11 , _ __— rc� __ Block__ / Subdivision
Street and Number where work is to be performed —No )___, S treet____.___ __
State work tome performed and purpose of building (By Floors)
B uilding
Remodeling Addition Repairs No. of Stories
-"'`--.. 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
matetials and /or workmanship.
Size c Se ti Tank Type .
p • T e of Tank_____ _— -____ ____ � � Capacity Gals •
Feet of Drain Tile LF 9 — _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well / — Size of Soakage Pit
Amount of Permit $ - /__.�" :
ss.
(Signed)
(Signed)
My Commission Expires Notary Public, State of Florida
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 5966, 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.
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
: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 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.
•
BU LDING
ELECTRICAL
PLUMBING
ROOF'!NG
Owner of
Building
Architect
Contractor
or Builder_
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE ' 17 ` _ 195
❑
PERMIT 'N° 11.932 Contractor's
License No
❑ Work to be performed under this Permit
•
CONTRACTOR OR BUILDER
BI.
Subdi-
vision
Value of
Project $
■!N
Amt. of
Permit $
This pen nit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and. regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • a w k _ BY � a
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform tl:,e work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
BUILDINGr ❑
ELECTRICAL PERMIT N9 8073
PLUMBING
ROOFING
El Work to be performed under this Permit
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
DATF 195
Contractor's
License No.
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed: BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances anfl regulations
pertaining thereto and in strict conformity with the plans, drawings, statements 017 specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
17
Permit No �!
New Building
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot____ _ __.__ _ ____ ____ Block
Siree
Street and Number where work is to be performed— No. o?m
Nature of Water Supply: City —Well
Amount of Permit $
Remodeling_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' k IT
Addition_
(Signed)
( Signed - z G gi w
Date
No.� �� l�?� Street.
My Commission Expires Notary Public, State of Florida
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 wilding 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 R: Ge,7f No. / ® ® Street / ' •
Subdivision
l
State work to be performed and purpose of building (By Floors)_ = __-
Repairs No. of Stories.
Size Septic Tank _ _ Type of Tank__ _ Capacity Gals
Feet of Drain Tile_ _______Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 5966, 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 per jp med under this permit, as are
licensed by Miami Shores Village. s �
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
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 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 will be made when suet re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER!
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tues
U RINALS
CATCH
BASIN
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
SW IM'G
POOL
CONTR.
LIST
.
CHECK
Permit No �!
New Building
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot____ _ __.__ _ ____ ____ Block
Siree
Street and Number where work is to be performed— No. o?m
Nature of Water Supply: City —Well
Amount of Permit $
Remodeling_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' k IT
Addition_
(Signed)
( Signed - z G gi w
Date
No.� �� l�?� Street.
My Commission Expires Notary Public, State of Florida
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 wilding 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 R: Ge,7f No. / ® ® Street / ' •
Subdivision
l
State work to be performed and purpose of building (By Floors)_ = __-
Repairs No. of Stories.
Size Septic Tank _ _ Type of Tank__ _ Capacity Gals
Feet of Drain Tile_ _______Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 5966, 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 per jp med under this permit, as are
licensed by Miami Shores Village. s �
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
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 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 will be made when suet re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
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.
Owner's Name and Address._ a__t.
Registered Architect and /or ineer_ -- _ - -- - -
Employing Plumber's Name /'
Location and Legal Description
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
Siva Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
CE &sue __- - - -> 2 "
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ►,�IiIT
(Signed)
No.__I_o__
_ Block
aea
Street
rC_
qi t/ 3 q
Date.. qJQ
Street
Street_ l r SD
Subdivisio
Repairs No. of Stories.
Type of Tank__ Capacity Gals.
__Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 5966, 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 poster]' 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.
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. )
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 dewoses 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 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
URINALS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU
/� \
TOTAL
FIXTURES
CONTR.
Liar
O
II
D --
CHECK
_____
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CoNTR.
LIST
CHICK
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.
Owner's Name and Address._ a__t.
Registered Architect and /or ineer_ -- _ - -- - -
Employing Plumber's Name /'
Location and Legal Description
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
Siva Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
CE &sue __- - - -> 2 "
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ►,�IiIT
(Signed)
No.__I_o__
_ Block
aea
Street
rC_
qi t/ 3 q
Date.. qJQ
Street
Street_ l r SD
Subdivisio
Repairs No. of Stories.
Type of Tank__ Capacity Gals.
__Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 5966, 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 poster]' 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.
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. )
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 dewoses 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 will be made when such re- :Inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No.. 1E°' "
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 o specified or not. A copy of approved plans and specifications must be kept .1
building during progress of work. _
Owner's Name and Address 1 No
Registered Architect and /or gineer
Mt v1O11 tl
Employing Plumber's Now 4)
Subdividon �y
Street and Number where work is to be performed —No JO Q 0 treat__ q !c .
State work to be performed and purpose of building (By . t
New Building..__.._ __.._...._......_.. Remodeling__—_--- ____.____ -- Addition. - .- .- _ —• - -_ Repair No. of Stories........
Location and Legal Description Lot.
Size Septic Tank_.._ Type of Tank__
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ..._.—_ -�—
Nature of Water Supply: City—Well Size of Soakage Pit
MIAMI SHOIRES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
rP� _
Amount of Permit $_1S (signed)._
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 5966, Compiled General Laws of Florida Permanent Supplement, and Ilan em-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract l played by him In the worb to be
performed under this permit; and will post or cause to be posted for inspection on the site of the
public notice or notices as err
required by the Act. The undersigned agrees to employ only such alb -oontr • ; 5, work be, ' nder this permit, as are
licensed by Miami Shores Village °
(Si
streeLivA 96
My Commission Expires Notary Public, State of Florida
Master Plumber.
STATE OF FLORIDA, 1
COUNTY OF DADE.
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 deposes and says that he is the •__ - -- .. _..-- •- •-- _ - - -.- _ _.... —. _..
of the above described construction, that be bar carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when snob asiupeotlen b made•neorerary by improper node. for inspection, or faulty
materials and /or worinaanship.
ur
CLosn
BATH
Tue•
aNOW[RO
LAVA•
TORIES
SINK[
SLOP
SINK[
LAUNDRY
Tun•
URINAL[
CATCH
SA[IN
FLOOR
DRAIN
DRINKING
FOUNT'N[
TOTAL
rI[YUR[[
CopTR.
LIST
CHICK
- _
-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DIM*
WELL
SPRKLR.
SYSTEM
SW IN•O
POOL
CONTR.
LIST
CHECK
Permit No.. 1E°' "
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 o specified or not. A copy of approved plans and specifications must be kept .1
building during progress of work. _
Owner's Name and Address 1 No
Registered Architect and /or gineer
Mt v1O11 tl
Employing Plumber's Now 4)
Subdividon �y
Street and Number where work is to be performed —No JO Q 0 treat__ q !c .
State work to be performed and purpose of building (By . t
New Building..__.._ __.._...._......_.. Remodeling__—_--- ____.____ -- Addition. - .- .- _ —• - -_ Repair No. of Stories........
Location and Legal Description Lot.
Size Septic Tank_.._ Type of Tank__
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ..._.—_ -�—
Nature of Water Supply: City—Well Size of Soakage Pit
MIAMI SHOIRES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
rP� _
Amount of Permit $_1S (signed)._
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 5966, Compiled General Laws of Florida Permanent Supplement, and Ilan em-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract l played by him In the worb to be
performed under this permit; and will post or cause to be posted for inspection on the site of the
public notice or notices as err
required by the Act. The undersigned agrees to employ only such alb -oontr • ; 5, work be, ' nder this permit, as are
licensed by Miami Shores Village °
(Si
streeLivA 96
My Commission Expires Notary Public, State of Florida
Master Plumber.
STATE OF FLORIDA, 1
COUNTY OF DADE.
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 deposes and says that he is the •__ - -- .. _..-- •- •-- _ - - -.- _ _.... —. _..
of the above described construction, that be bar carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when snob asiupeotlen b made•neorerary by improper node. for inspection, or faulty
materials and /or worinaanship.