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PLUMBINGBUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA ❑ p DATE �� . '� 195 El PERMIT 13758 Contractor's P License No. — ❑ Work to be performed under this Permit 'BL Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device dektibed in the application herefor in strict compliance with all ordinances pertaining tblereto and with the understanding that the work will be performed in ' with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Pere um 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 which this permit is granted is the understanding that the contractor or builder n above assumes the responsibility for a thorough knowledge of the and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he a = for work done by his agents, servants or employees. Signed BY INSPE R BY 11 Amt. of Permit 8 In consideration of the issuance to me of this permit agree to perf rtll�l'fi e work covered hereunder in compliance with an; and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of s Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Permit No. 1 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 the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior 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._ _ Street Registered Architect and /or Engineer ______ _____ _____ ...... __..- _— _._ - -_ - __ -• Employing Plumber's Name J,:, ∎ = � _ , ,----- Location and Legal Description Lot_ .... ----- ____ -_ -- Block— . _.-- _--- ____ -- - __ - - -. Subdivisign Street and Number where work is to be performed —No J _ki__ >_ —J....4 4 ____ Street._ -.. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition._-_ ..... . ...... ._._._ Repairs . ... ... ..... No. of Stories Size Septic Tank_ Type of Tank_ — Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from We1L Nature of Water Supply: City—Well ......... _______ ..... ______.______._.______.Size of Soakage Pit a Amount of Permit $ .- -____ - -__ - - - -- — (Signed) -._ __ , Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as al, employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Supplement, and has 0;in- 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 seek to /performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ ' Date � �......�.. Street aster Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tac therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fait' materials and /or workmanship. CLOSETS BATH TUBS SHOWLRO LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N5 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 l5T 6 0 CHECK Permit No. 1 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 the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior 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._ _ Street Registered Architect and /or Engineer ______ _____ _____ ...... __..- _— _._ - -_ - __ -• Employing Plumber's Name J,:, ∎ = � _ , ,----- Location and Legal Description Lot_ .... ----- ____ -_ -- Block— . _.-- _--- ____ -- - __ - - -. Subdivisign Street and Number where work is to be performed —No J _ki__ >_ —J....4 4 ____ Street._ -.. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition._-_ ..... . ...... ._._._ Repairs . ... ... ..... No. of Stories Size Septic Tank_ Type of Tank_ — Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from We1L Nature of Water Supply: City—Well ......... _______ ..... ______.______._.______.Size of Soakage Pit a Amount of Permit $ .- -____ - -__ - - - -- — (Signed) -._ __ , Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as al, employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Supplement, and has 0;in- 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 seek to /performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ ' Date � �......�.. Street aster Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tac therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fait' 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 otlus 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 Divisior 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. M 44 1 O A/ No._--__-- / 2 Street /V q7 " ri Registered Architect and /or Engineer.---._- ___ _-- ____ -- Employing Plumber's Name $') frit l • ` 61, _._ No.__ -. _ Street--_ an 1 I n .' _ Location and Legal Description Lot_______-____.__. ..... ___. J__.__ —...._ ._.__ Block..._.____!._.. -_.- - .___... Subdivision in _ 4 . Street and Number where work is to be performed —No �� o _ State work to be performed and purpose of building (By Floors) New Building _ ._._ -.___ Remodeling Addition. Size Septic Tank. Type of Tank_ Feet of Drain T;1e _.___ _. // Dist. Feet of Tank or Drain Field from WeIL_ ____.____ Nature of Water Sup • y: City— ell C__ - �� _ Size of Soakage Pit .. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs_ Street ' 7 TH S1 Capacity Gals. _ -- ( Signed) _ Date- l — 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 5966, Compiled General Laws of Florida Pennanent Supplement, and hu.. :• _n- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wo :-k 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 be performe., nder this remit, as an licensed by Miami Shores Village. (Signed)._ Master P4um STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship. CLOSETS B ATH TUBS SHOWSRS LAVA- TORIES SINKS IN SINKS LAUN Tu8 UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS WSW 140/1450611e TOTAL FIXTUREI —_ CONTR. LIST l t Z / _ _ °� f S 1 CHECK 1 7 S �- �� / Y y ri : sue / d c) SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP iRRP HEATER DU" WELL SPRKLR. SYSTEM SWIM'G POOL iv--- kd CONTR. LIST 1 G • / 66 7� '� ► L./ ,': 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 otlus 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 Divisior 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. M 44 1 O A/ No._--__-- / 2 Street /V q7 " ri Registered Architect and /or Engineer.---._- ___ _-- ____ -- Employing Plumber's Name $') frit l • ` 61, _._ No.__ -. _ Street--_ an 1 I n .' _ Location and Legal Description Lot_______-____.__. ..... ___. J__.__ —...._ ._.__ Block..._.____!._.. -_.- - .___... Subdivision in _ 4 . Street and Number where work is to be performed —No �� o _ State work to be performed and purpose of building (By Floors) New Building _ ._._ -.___ Remodeling Addition. Size Septic Tank. Type of Tank_ Feet of Drain T;1e _.___ _. // Dist. Feet of Tank or Drain Field from WeIL_ ____.____ Nature of Water Sup • y: City— ell C__ - �� _ Size of Soakage Pit .. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs_ Street ' 7 TH S1 Capacity Gals. _ -- ( Signed) _ Date- l — 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 5966, Compiled General Laws of Florida Pennanent Supplement, and hu.. :• _n- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wo :-k 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 be performe., nder this remit, as an licensed by Miami Shores Village. (Signed)._ Master P4um STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA ❑ p DATE �� . '� 195 El PERMIT 13758 Contractor's P License No. — ❑ Work to be performed under this Permit 'BL Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device dektibed in the application herefor in strict compliance with all ordinances pertaining tblereto and with the understanding that the work will be performed in ' with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Pere um 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 which this permit is granted is the understanding that the contractor or builder n above assumes the responsibility for a thorough knowledge of the and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he a = for work done by his agents, servants or employees. Signed BY INSPE R BY 11 Amt. of Permit 8 In consideration of the issuance to me of this permit agree to perf rtll�l'fi e work covered hereunder in compliance with an; and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of s Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Permit No. 1 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 the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior 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._ _ Street Registered Architect and /or Engineer ______ _____ _____ ...... __..- _— _._ - -_ - __ -• Employing Plumber's Name J,:, ∎ = � _ , ,----- Location and Legal Description Lot_ .... ----- ____ -_ -- Block— . _.-- _--- ____ -- - __ - - -. Subdivisign Street and Number where work is to be performed —No J _ki__ >_ —J....4 4 ____ Street._ -.. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition._-_ ..... . ...... ._._._ Repairs . ... ... ..... No. of Stories Size Septic Tank_ Type of Tank_ — Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from We1L Nature of Water Supply: City—Well ......... _______ ..... ______.______._.______.Size of Soakage Pit a Amount of Permit $ .- -____ - -__ - - - -- — (Signed) -._ __ , Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as al, employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Supplement, and has 0;in- 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 seek to /performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ ' Date � �......�.. Street aster Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tac therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fait' materials and /or workmanship. CLOSETS BATH TUBS SHOWLRO LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N5 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 l5T 6 0 CHECK Permit No. 1 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 the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior 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._ _ Street Registered Architect and /or Engineer ______ _____ _____ ...... __..- _— _._ - -_ - __ -• Employing Plumber's Name J,:, ∎ = � _ , ,----- Location and Legal Description Lot_ .... ----- ____ -_ -- Block— . _.-- _--- ____ -- - __ - - -. Subdivisign Street and Number where work is to be performed —No J _ki__ >_ —J....4 4 ____ Street._ -.. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition._-_ ..... . ...... ._._._ Repairs . ... ... ..... No. of Stories Size Septic Tank_ Type of Tank_ — Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from We1L Nature of Water Supply: City—Well ......... _______ ..... ______.______._.______.Size of Soakage Pit a Amount of Permit $ .- -____ - -__ - - - -- — (Signed) -._ __ , Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as al, employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Supplement, and has 0;in- 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 seek to /performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ ' Date � �......�.. Street aster Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tac therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fait' 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 otlus 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 Divisior 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. M 44 1 O A/ No._--__-- / 2 Street /V q7 " ri Registered Architect and /or Engineer.---._- ___ _-- ____ -- Employing Plumber's Name $') frit l • ` 61, _._ No.__ -. _ Street--_ an 1 I n .' _ Location and Legal Description Lot_______-____.__. ..... ___. J__.__ —...._ ._.__ Block..._.____!._.. -_.- - .___... Subdivision in _ 4 . Street and Number where work is to be performed —No �� o _ State work to be performed and purpose of building (By Floors) New Building _ ._._ -.___ Remodeling Addition. Size Septic Tank. Type of Tank_ Feet of Drain T;1e _.___ _. // Dist. Feet of Tank or Drain Field from WeIL_ ____.____ Nature of Water Sup • y: City— ell C__ - �� _ Size of Soakage Pit .. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs_ Street ' 7 TH S1 Capacity Gals. _ -- ( Signed) _ Date- l — 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 5966, Compiled General Laws of Florida Pennanent Supplement, and hu.. :• _n- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wo :-k 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 be performe., nder this remit, as an licensed by Miami Shores Village. (Signed)._ Master P4um STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship. CLOSETS B ATH TUBS SHOWSRS LAVA- TORIES SINKS IN SINKS LAUN Tu8 UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS WSW 140/1450611e TOTAL FIXTUREI —_ CONTR. LIST l t Z / _ _ °� f S 1 CHECK 1 7 S �- �� / Y y ri : sue / d c) SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP iRRP HEATER DU" WELL SPRKLR. SYSTEM SWIM'G POOL iv--- kd CONTR. LIST 1 G • / 66 7� '� ► L./ ,': 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 otlus 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 Divisior 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. M 44 1 O A/ No._--__-- / 2 Street /V q7 " ri Registered Architect and /or Engineer.---._- ___ _-- ____ -- Employing Plumber's Name $') frit l • ` 61, _._ No.__ -. _ Street--_ an 1 I n .' _ Location and Legal Description Lot_______-____.__. ..... ___. J__.__ —...._ ._.__ Block..._.____!._.. -_.- - .___... Subdivision in _ 4 . Street and Number where work is to be performed —No �� o _ State work to be performed and purpose of building (By Floors) New Building _ ._._ -.___ Remodeling Addition. Size Septic Tank. Type of Tank_ Feet of Drain T;1e _.___ _. // Dist. Feet of Tank or Drain Field from WeIL_ ____.____ Nature of Water Sup • y: City— ell C__ - �� _ Size of Soakage Pit .. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs_ Street ' 7 TH S1 Capacity Gals. _ -- ( Signed) _ Date- l — 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 5966, Compiled General Laws of Florida Pennanent Supplement, and hu.. :• _n- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wo :-k 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 be performe., nder this remit, as an licensed by Miami Shores Village. (Signed)._ Master P4um STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship.