1041 NE 96 St (9)i ce J7
1
r r ° F; ;y
Permit No..494
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_. a
(Signed)
Date...NQYe 11.. 1983 _ _
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 Dopy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address _Joa.e4111.1iltia Jr, No_ &.9 Street. ii Shores ..
Registered Architect and /or Engineer
Employing Plumber's Name Lloyd Septic, oaf Se � NO W 1 1 1 ...... itr„e,_Miami , 33168
Location and Legal Description Lot_ Blorf< Subdivision. ___—..
Street and Number where work is to be p 1041 NE 96 St . street. Miami Shores
State work to be performed and purpose of building (By Floors)
New Building ..__.._._____. ..... ...._.. Remodeling_____.._.___ Addition...___..__ Repair No. of Stories. . .....
Size Septic Tank.__ Type of Tank —_
Feet of Drain Tile 20.0 .-- Lt-.Dist. Feet of Tank or Drain Field from Well ..._.___ __________ ... _
Nature of Water Supply: City —We1L Size of Soakage Pit
Capacity Gals..._..._...__
My Commission Expires Notary Publlo, 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 5908, Compiled General Laws of Florida Permanent Supplement, and hay mm-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort: 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 err
required by the Act. The undersigned agrees to employ only such sub - contractor, on work to be performed ui+der this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 1 a.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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 has 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 $L00 will be made wham snob Mowed= made.naesssary by improper notice for inspection, or faulty
materials and /or w orl®aoship.
CLOSETS
BATH
TU..
SNOWERn
LAVA.
TORIES
SINKS
BLOB
SINKS
LAUNDRY
Tuns
URINALS
I NALa
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N.
TOTAL
FIXTURES
CONTN.
LIST
k
CHECK
'
—
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW 114 •0
POOL
CONTR.
LIST
CHECK
�
i ce J7
1
r r ° F; ;y
Permit No..494
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_. a
(Signed)
Date...NQYe 11.. 1983 _ _
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 Dopy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address _Joa.e4111.1iltia Jr, No_ &.9 Street. ii Shores ..
Registered Architect and /or Engineer
Employing Plumber's Name Lloyd Septic, oaf Se � NO W 1 1 1 ...... itr„e,_Miami , 33168
Location and Legal Description Lot_ Blorf< Subdivision. ___—..
Street and Number where work is to be p 1041 NE 96 St . street. Miami Shores
State work to be performed and purpose of building (By Floors)
New Building ..__.._._____. ..... ...._.. Remodeling_____.._.___ Addition...___..__ Repair No. of Stories. . .....
Size Septic Tank.__ Type of Tank —_
Feet of Drain Tile 20.0 .-- Lt-.Dist. Feet of Tank or Drain Field from Well ..._.___ __________ ... _
Nature of Water Supply: City —We1L Size of Soakage Pit
Capacity Gals..._..._...__
My Commission Expires Notary Publlo, 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 5908, Compiled General Laws of Florida Permanent Supplement, and hay mm-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort: 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 err
required by the Act. The undersigned agrees to employ only such sub - contractor, on work to be performed ui+der this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 1 a.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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 has 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 $L00 will be made wham snob Mowed= made.naesssary by improper notice for inspection, or faulty
materials and /or w orl®aoship.