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PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /G - 23 Job Address /'4 , Zi( 57 l •C K - Tax Folio /' c? �' S / 7 e) Z i e_ ' :_, Legal Description // , ' - , r'' /7 7 / — -- // ,1 M 1 Si-iC . �= `� iI2� i3 k-ceJ_ /y/ �� � Owner / Lessee / Tenant �A/ O � %/l '/% <rJ Master Permit i 0 Owner's Address /404 7y, -7 Phone Contracting Co. /?C S� (.='61 5 7 0 !f /Nr Address % f .S /77' : r .4:1 4,i1,' () Qualifier t.� E �� 1_,, l ` ./ Ff l I SS# 4 7 /Phone , 3 L� .r e 7 z �' --,/ 6 ,,,,, State # Municipal # Competency # Ins.Co. .SCE 2 tf/ /f i"r'/y Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL( PLUMBING/ MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION //) k / f Gt�e�Ci� / �� ��J r ._ / � /lam' - 72,7 / /r Zoning Buildin Mechanical Plumbin Square Ft. Estimated Cost(value) f c WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work state Signature of owner and /or Condo President Signat� dtrapt'or or Owner- Builder Date: Date: %'/9 Notary as to Owner and /or Condo President b"o'ary as to C My Commission Expires: M' Commission fir: " �'J r.so n Exp. pn 30, , a;:' No CCI97545 ** * * * * * * * * * * * * * * * * ** FEES: PERMIT 22/ RADON C.C.F. NOTARY TOTAL DUE cam'— - ; e APPROVED: Fire Other Electrical Engineering BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA I PERMIT N° 9572 Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building Bl. Subdi- vision Value of Project $ DATE 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 he 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: ' i _BY INSPECTOR .."" In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with aeordpnances and regulation perta ing thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shoo. -` "" In a�eep assume response i this pessvii /fir f ,I 1ity for all work done by either, myself, my agent, servant or employee. r > y/ 1)'' . .. -,. CONTRACTOR OR BUIL BY 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 he kept at building during progress of work. ,)) Owner's Name and Address �" No Street Registered Architect and /or Engineer_ Employing Plumber's Name f- ._',`___ • ' No. Street l / Location and Legal Description Lot Block Subdivision ' , " I " __ oc c _ u d�vrsron_; -:__ l _ Street and Number where work is to be performed —No Street __._a C__ . ___— State work to be performed and purpose of building (By Floors) New Building CONTR. LIST CHECK CONTR. I / LIST J / CHECK Feet of Drain Tile _______ Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. CLOSETS SEPTIC TANK BATH TUBS SEWER CONN. SHOWERS ss. fr DRAIN FIELD My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling Addition________________ ______. Repairs. LAVA- TORIES SOAKAGE PIT SINKS GREASE TRAP SLOP SINKS HEATER LAUNDRY TUBS 1 DEEP WELL (Signed) URINALS SPRKLR. SYSTEM Nature of Water Supply: City —Well. _ Size of Soakage Pit CATCH BASIN SWIM'G POOL FLOOR DRAIN (Signed) __lf Date DRINKING % FOUNT'NS Size Septic Tank - - -- Type of Tank Capacity Gals._ Dist. Feet of Tank or Drain Field from Well Notary Public, State of Florida _ No. of Stories . TOTAL FIXTURES 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 he 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, ory work to be performed under this permit, as are licensed by Miami Shores Village. � ` ` Master 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 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. 4 4 c,,c -410 J C LOSETS BATH T ua6 SH LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tugs URINALS CATCH BASIN FLOOR DRINKING DRAIN FOUNT•N6 TOT..L FIRTL REM CONTA. LI T 1 CHECK _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WILL SPRKLR. SYSTEM SWIIM'G POOL Gown,. LIST __ _ . I .. CHECK Penn Nu.. Z -Z ,Sppbr.,ttun is hereby made for the approval of the detailed statement of the plans and specifications herewith subr.r• .1 for the building or other tructure herein described. This application is made in compliance and conformity with the Building Ordinance of Min ! Shores Village, Florida, a,;d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic ' of the Building Division of Miami Shores Village shall be complied with, whether herein specified or mot. A copy of approved plans and spec fications must be kept at 73uilding during progress of work. 'hvner's Name and Address----•--..- .._��COO�g -- No. 1044 _. _ _ Street. - .. NE 97 S o .egist!red Architect and /or Engines!: :mploying Plumber's Name .0....G-oL1 _Septic Laixak -_Sle o... ,,,. Sf88st..,.. ,., 11 St. .... Location and Legal Description Lot Block Street and Number where work is to be performed —No 1044 NE 97 St ° Street State work to be performed and purpose of building (By Floors) _... .- --- -- New Building ........... ..... Remodeling_ — ..... Addition- -- --.._ Repairs No of Stones Size Septic Tank_ -. -- •--- ..... -_- - ..------- •- - - - - -- -.Type of Tank_ Feet of Drain Tile.. 138 SQ g$- 4-- IDist. Feet of Tank or Drain Field from Well. . .. - ..- Nature of Water Supply: of Soakage Pit Amount of Permit $tai STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (si .A. : -'Cl lI—U? Plumbire; Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n;,Ioyc7 of !abet under the Florida Workrnen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent ruin lament, and Ilan ••n•r• bed with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in ' e ‘+•I f v b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such puhl' notice o; no ice:* cs a• required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed '.x this � r.ric td at licensed by Miami Shores Village. �- 7 (Sign Capacity ^ >.aals. My Commission Expires Notary Public, State of Florida Mast a Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per:w . r pprarec 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 seine, and that all acts therein by hin, stated are true. NOTE: A re- inspection fee of $1.00 will be made when ouch r 4especdors is made •neoswary by improper notice for Grape ten, at totally materials and/or workmanship. CLOSrTS BATH Tuee SHOWER• LAVA• TORIES SINKS SLOP SINKS LAUNDRY Tuts URINALS CATCH DRAIN FLOOR DRAIN DRINKING FOUNT' NS TOT. -L F WTI. RES CONTR. LI CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM 'O POOL __� ®s CoNT *. LIST CHICK Penni, Nu. . " Size Septic Tank____ /if!/ _ ______...Type of Tank- ---- - - - - -- - -- - -- • 14 Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Capacity ^ Palp.. (Signed) WQ.A•a 9411.E \ 3 5 Date..._ .. / ®. g_(/ d : , is hereby mode for the approval of the detailed statement of the plans and specifications herewith subr u• .1 for the building or other tructure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi. f Shores Village, Florida. 4,;d all pros isions of the Laws of the State of I•'lorida, all ordinances of Miami Shores Village and all rules and regulatic • of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plane and spec fications mutt be kept at ',wilding during progress of work. • `.)wner's Name and Address. ..��,er 10 .1._.__..____.. _ 00__00_. No. Le iii .!C Street.._... % P .egist.red Architect and /or En uteer F+' d a 4), employing Plumber's Name 4./7 .�_.L ,_ . re.._4 4 •. ' No. a.s. , Wrie ,,..1 .9 � r ' , �/�- Location and Legal Description Lot_ Bloch / 7/ Subdivision.04 .�' Street and Number where work is to be performed —No / V 5 / Street. .. 7 S , . State work to be performed and purpose of building (By Floors) a,ztv.4. feay .4' 6 . New Building Remodeling-__ _ ..... _._ Addition...__._ Repairs Nv of Stones Feet of Drain Tile.__.__ __ —•_ -- __._Dist. Feet of Tank or Drain Field from Well .----...--•.----- • - -..- Nature of Water Supply: City — Well,____.__._.._.._ _ _. -___—_ -_Size of Soakage Pit j l My Cnnunission Expires Notary Public, State of Florida Plumbin'; Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n,riovei of ta}K>t under the Florida Workrnen's Compensation Act, being Section 54186, Compiled General Laws of Florida Permanent rum, lenient, and lids 0 01 - 1- lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in • ,..LI rk performed under this permit; and will post or cause to be posted' for inspection on the site of the work such publ; notice T. no leer rs required by the Act. The undersigned agrees to employ only such cub - contractors, on work to be performed 1 .a this in rig ar . licensed by Miami Shores Village. Mast a Plumber. STATE OF FLORIDA, 1 d COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per.;urrt ; , ppearec to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the .................... . .0000. .. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and tssat all acts therein by him stated are true. NOTE: A re inspection fee of $1.00 will be made when etch rein i® mede'neoessary by improper notion for inapeefowe. (Ir teeny materials and /or workmanship. Permit No-_ Date -- , — A_ - _., - Application is hereby made for the approval of the detailed statement of Er., plans and specifications herewith submiitted for the building or other structure herein described. This application is made in compliance and confex s:i,y with the rmilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Vilag.a and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified n= rrt. A copy of approved plans and specifications must be kept at building during progress of work. Owner a Name and Address !� _ o ___ /_ /� L' Registered Arc°r_'.tect and /or Engineer- -___--- Employing Plumber's Name — -� ' - - � /j _ )-` e '7 > �_ No. - ./ `� ` )'� l � ,` ' % n c t -_� �_ rr� Street--_ c Subdivision__ Street Location and Legal Description L Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Iuilding Remodeling____ _____ Addition Siam Septic Tank Feet of Drain Tile Nature. of Water Supply: City—WP.-11 — o q i ci >`,UOAMI SHOR1S VIC,;_AGE PLUMBING INSPECTION DEPARTMEI< APPL CATION FOR PLUM39N1 " Amount of Permit $.. - ----------- _--------------- -_____ (Signed)_ STATE OF FLORIDA, COUNTY OF DADE. Repairs No. of Stories_ Type of Tank Capacity Gals _Dist. Feet of Tank or Drain Field from Well —.1_ Size of Soakage Pit 4 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 requi 1 by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are °'trrtrsed by MIR2 it Shores Village. y (Signed) _ 2 Master Plumber. 3efore 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. 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 faulty matcriaks and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK NG FOUNT' NS TOTAL FI %TURES C:1NYR. LIST CN ECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIBT CNQC11 � — _— Permit No-_ Date -- , — A_ - _., - Application is hereby made for the approval of the detailed statement of Er., plans and specifications herewith submiitted for the building or other structure herein described. This application is made in compliance and confex s:i,y with the rmilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Vilag.a and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified n= rrt. A copy of approved plans and specifications must be kept at building during progress of work. Owner a Name and Address !� _ o ___ /_ /� L' Registered Arc°r_'.tect and /or Engineer- -___--- Employing Plumber's Name — -� ' - - � /j _ )-` e '7 > �_ No. - ./ `� ` )'� l � ,` ' % n c t -_� �_ rr� Street--_ c Subdivision__ Street Location and Legal Description L Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Iuilding Remodeling____ _____ Addition Siam Septic Tank Feet of Drain Tile Nature. of Water Supply: City—WP.-11 — o q i ci >`,UOAMI SHOR1S VIC,;_AGE PLUMBING INSPECTION DEPARTMEI< APPL CATION FOR PLUM39N1 " Amount of Permit $.. - ----------- _--------------- -_____ (Signed)_ STATE OF FLORIDA, COUNTY OF DADE. Repairs No. of Stories_ Type of Tank Capacity Gals _Dist. Feet of Tank or Drain Field from Well —.1_ Size of Soakage Pit 4 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 requi 1 by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are °'trrtrsed by MIR2 it Shores Village. y (Signed) _ 2 Master Plumber. 3efore 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. 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 faulty matcriaks and /or workmanship. ;UILDING :LECTRICAL 'LUMBING - OOFING )weer of uilding rchitect ontractor Builder MIAMI SHORES VILLAGE. FLORIDA , ❑ ❑ DATF 195 ' PERMIT N° 3104 Contractor's License No. .gal Lot escription ddress of gilding Work to be performed under this Permit Bl. Subdi- vision Value of Amount of Project $ 1 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 ‘refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, swings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any le 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations rtaining 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 ne 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 and regulations rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- ,ting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY o Permit No.. ;1� 6 Size Septic Tank Feet of Drain Tile._____ -_ Nature of Water Supply: City —Well. STATE OF FLORIDA, ss. COUNrl OF DADE. MIAMI SHORES VI °:AGE PLUMBING INSPECTION DEPARTME APPLICATION FOR PLUMBMS yt Amount of Permit _- __-_--- _________________ —_ _ — (Signed)_ - -�� (Signed) Date 1 -3 Application is hereby made for the approval of the detailed statement of tnv plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and confer y with the Suilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Villags and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified e- no. 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 E gineer / / Employing Plumber's Name � ' � d �' ?/"/ `- Z J No.__.__ ?' ' "®1= Street/ No. /a _ -- __ -- Street �' Y7 Location and Legal Description Lot - - - - -- _ - - - - -- __.------ _ -__ -_ — Block_ _-------- _ - -• -- Subdivision Street and Number where work is to be performed— No.. -__ / 'J Streets{ State work to be performed and purpose of building (By Floors)_ — _-----------_• Ncw Building ____ ___ Remodeling___— ____ Addition._._.___.__.._..______ 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 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 lice .;ed by Miami Shores Village. BeScte me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to xne 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 to ein';y hi.!r, stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE,: A re- inspection fee of $I.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty maim-Ws axid/cr workmanship. CLOSETS BATH TUBE SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. FACT CWHCCt SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP " WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIUT CP:3CK _ Permit No.. ;1� 6 Size Septic Tank Feet of Drain Tile._____ -_ Nature of Water Supply: City —Well. STATE OF FLORIDA, ss. COUNrl OF DADE. MIAMI SHORES VI °:AGE PLUMBING INSPECTION DEPARTME APPLICATION FOR PLUMBMS yt Amount of Permit _- __-_--- _________________ —_ _ — (Signed)_ - -�� (Signed) Date 1 -3 Application is hereby made for the approval of the detailed statement of tnv plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and confer y with the Suilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Villags and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified e- no. 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 E gineer / / Employing Plumber's Name � ' � d �' ?/"/ `- Z J No.__.__ ?' ' "®1= Street/ No. /a _ -- __ -- Street �' Y7 Location and Legal Description Lot - - - - -- _ - - - - -- __.------ _ -__ -_ — Block_ _-------- _ - -• -- Subdivision Street and Number where work is to be performed— No.. -__ / 'J Streets{ State work to be performed and purpose of building (By Floors)_ — _-----------_• Ncw Building ____ ___ Remodeling___— ____ Addition._._.___.__.._..______ 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 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 lice .;ed by Miami Shores Village. BeScte me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to xne 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 to ein';y hi.!r, stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE,: A re- inspection fee of $I.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty maim-Ws axid/cr workmanship.