250 NE 97 St (9)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
❑ PERMIT N? 15530
❑ Work to be performed under this Permit
Architect
Contractor
or Builder
Legal Lot II BI.
Description
Address of
Building `; i
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
DATE 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 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
Permit No. 7
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 _ - -- -- -- - - -- -- - ----------------- -___ -� No. Street
Location arid Legal Description Lot____ _- - - -_ -_ _ Block_ - -_ --- - - -_ -_ _ -- -__ - -- Subdivision
------- __.._ --
Street and Number where work is to be performed —No Street ��✓
State work to be performed and purpose of building (By Floors)_ .._
New Building ___._
V
Size Septic Tank. .__ ____ -- Type of Tank__— ....
Amount of Permit $_
Remodeling Addition.
Repairs
Capacity Gals
Feet of Drain Vie ........ - -- - - ---- --- -- --_Dist. Feet of Tank or Drain FIeld from Well _ - __ -__ - --- __ - ____
Nature of Water Supply City - Well , ___ Size of Soakage Pit ___.
Date ............... [ ._�° `.:.
•
My Commission Expires Notary Public, State of Florida
No of Stories
( Signed) - - - ✓r } ° --
Plumbing Ins)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a employet inbr
under the Florida Workmen's Compensation Act, being Section 5986, Compiled 'General Laws of Florida Permanent Supplement, and ,�-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in tr, v✓o k Lo 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 noiiim ss are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under taus I'crnait, as are
licensed by Miami Shores Village.
\ J 4
(Signed)- - ---•- - - - -- -- --- ---- -- -
� Master Plumber.
STATE OF FLORIDA, } r� C '
COUNTY OF DADE. �. u
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or f,.ul
materials and /or workmanship.
CLOUETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINK*
LAUNDRY
TUB*
URINALS
CATCH
DRBIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
•l/�'7
SI?
/. *':
--
TOTAL
FIXTURLI
C 8T
`7
i
CHECK
, >
C .i �'
:-
ik
1; ,'
' -1l ` -.
-
---
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
6 REALM
TRAP
litC4413
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CLIST
LIST
U
CHECK
-
i •'
-;C%
Permit No. 7
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 _ - -- -- -- - - -- -- - ----------------- -___ -� No. Street
Location arid Legal Description Lot____ _- - - -_ -_ _ Block_ - -_ --- - - -_ -_ _ -- -__ - -- Subdivision
------- __.._ --
Street and Number where work is to be performed —No Street ��✓
State work to be performed and purpose of building (By Floors)_ .._
New Building ___._
V
Size Septic Tank. .__ ____ -- Type of Tank__— ....
Amount of Permit $_
Remodeling Addition.
Repairs
Capacity Gals
Feet of Drain Vie ........ - -- - - ---- --- -- --_Dist. Feet of Tank or Drain FIeld from Well _ - __ -__ - --- __ - ____
Nature of Water Supply City - Well , ___ Size of Soakage Pit ___.
Date ............... [ ._�° `.:.
•
My Commission Expires Notary Public, State of Florida
No of Stories
( Signed) - - - ✓r } ° --
Plumbing Ins)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a employet inbr
under the Florida Workmen's Compensation Act, being Section 5986, Compiled 'General Laws of Florida Permanent Supplement, and ,�-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in tr, v✓o k Lo 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 noiiim ss are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under taus I'crnait, as are
licensed by Miami Shores Village.
\ J 4
(Signed)- - ---•- - - - -- -- --- ---- -- -
� Master Plumber.
STATE OF FLORIDA, } r� C '
COUNTY OF DADE. �. u
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or f,.ul
materials and /or workmanship.
t yr,"1
,
c,
„
Permit No L
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 Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications mwt be kept at
building during progress of work.
Owner's Name and Address (/ ✓J-r�� No I -, Street..2 • . _ __ ..
Registered Architect and /or Engineer 34/.7 ?
Employing Plumber's Name .. - Y .- • C'' - No..,. . ..Zt .. trseR
Location and Legal Description Lot. Blot -7.0 Subdivision-...
Street and Number where work is to be performed -No - 2 — ' A7, 77,i-4/Street . - - -._. _..._..._._
State work to be performed and purpose of building (By Floors)__.-.- - -._ -- _ __._.-- _- --....._....._.._._
New Building -- ._--- ._.........._.. Remodeling__-_...._._._ __ Addition.
Amount of Permit $
Date
Repairs
Size Septic Tank__ Type of Tank _. ... -_____Capacity Cale...- ..._...__
Feet of Drain Tile _Dist Feet of Tank or Drain Field from Well ..._. _ - __---.-----__--
Nature of Water Supply: City-Well. Size of Soakage Pit.
11.E ,a
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 5986, Compiled General Laws of Florida Permanent Supplement, and IIu' com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him In the woe 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-coat by performed undeJr this permit, as are
licensed by Miami Shores Village.
( 1 , `q �2"O
No. of Stories ........
,/L3— dee
STATE OF FLORIDA, 1 µ
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 be is the ...__.._ .. _ ....---- - - - - -- - - -. - -.
of the above described construction, that be has carefully read the foregoing sppliation, and that be 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 wham swab re•speetkoa Y snada by Improper node. for Inspection, at faulty
materials and/or workmanship.
CLOSETS
BATH
-r Yet
LAVA-
TORIES
a1NKS
SLOP
SINKS
LAUNORY
Tugs
URINAL!
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIATURtS
CONTR.
LIST
CHICK
—�
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
NEATER
Our
WELL
SPRKLN.
SYSTEM
eW IM'G
POOL
CONTR.
LIST
CHECK
_
Permit No L
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 Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications mwt be kept at
building during progress of work.
Owner's Name and Address (/ ✓J-r�� No I -, Street..2 • . _ __ ..
Registered Architect and /or Engineer 34/.7 ?
Employing Plumber's Name .. - Y .- • C'' - No..,. . ..Zt .. trseR
Location and Legal Description Lot. Blot -7.0 Subdivision-...
Street and Number where work is to be performed -No - 2 — ' A7, 77,i-4/Street . - - -._. _..._..._._
State work to be performed and purpose of building (By Floors)__.-.- - -._ -- _ __._.-- _- --....._....._.._._
New Building -- ._--- ._.........._.. Remodeling__-_...._._._ __ Addition.
Amount of Permit $
Date
Repairs
Size Septic Tank__ Type of Tank _. ... -_____Capacity Cale...- ..._...__
Feet of Drain Tile _Dist Feet of Tank or Drain Field from Well ..._. _ - __---.-----__--
Nature of Water Supply: City-Well. Size of Soakage Pit.
11.E ,a
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 5986, Compiled General Laws of Florida Permanent Supplement, and IIu' com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him In the woe 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-coat by performed undeJr this permit, as are
licensed by Miami Shores Village.
( 1 , `q �2"O
No. of Stories ........
,/L3— dee
STATE OF FLORIDA, 1 µ
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 be is the ...__.._ .. _ ....---- - - - - -- - - -. - -.
of the above described construction, that be has carefully read the foregoing sppliation, and that be 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 wham swab re•speetkoa Y snada by Improper node. for Inspection, at faulty
materials and/or workmanship.
Location and Legal Description Lot.
Amount of Permit $ Q.� o
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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. p� �' p
Owners Name and Address s�.°� -- it ¢ 1 No d D Street.aT ST- K. I�
Registered Architect and /or Engineer
Employing Plumber's Name :T C G - e t S crtl.
Street and Number where work L to be performed —No a.-C70 9
State work to be performed and purpose of building (By ) - -----
New Building. _ .— _------- ......._.. Remodeling —_ -- Addition...
Size Septic Tank_ -Type of Tank-- -
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well .__ _ - - -.—
Nature of Water Supply: City—WeIL 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 5989, Compiled General Laws of Florida Permanent Supplement, and hav com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worir 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 es are
required by the Act. The undersigned agrees to employ only such sub-contractors, on .' k to be performed under this permit, KS are
licensed by Miami Shores Village.
•
L40#S Sub division2A16Lva.Q. =
21— Street- . ._..__. — ..._..._._ �_
.__ Repairs
(Shined)
No. of Stories
Master Plumber.
STATE OF FLORIDA, 1 ss.
COUNTY OF DADE. i
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowkdgments, personally appeared
to me well known, and who, being by me first duly swan, upon oath deposes and says that he is the - -- •-- •---- -• - -.- _ _.... —.
of the above described construction, that he has cansfully read the foregeilxg application, and that be did sign the same, and that all facts
therein by him stated are true.
M Commisaion Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be arcade Reds celaspsedus V mada nsesssmy by improper notice for inspection. or faulty
material and/or workmanship.
CLOSETS
BATH
Tuss
.MOWERS
LAVA.
TORIEP
GIN"
S
SLOP
SINK•
LAUNDRY
Tuns
U RINAL!
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
riaTURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
80AKA0[
PIT
GREASE
TRAP
SOLAR
HIATER
DEEP
WELL
8PRKLR.
SYSTEM
SW IM'0
POOL
CONTR.
LIST
U
CHECK
Location and Legal Description Lot.
Amount of Permit $ Q.� o
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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. p� �' p
Owners Name and Address s�.°� -- it ¢ 1 No d D Street.aT ST- K. I�
Registered Architect and /or Engineer
Employing Plumber's Name :T C G - e t S crtl.
Street and Number where work L to be performed —No a.-C70 9
State work to be performed and purpose of building (By ) - -----
New Building. _ .— _------- ......._.. Remodeling —_ -- Addition...
Size Septic Tank_ -Type of Tank-- -
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well .__ _ - - -.—
Nature of Water Supply: City—WeIL 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 5989, Compiled General Laws of Florida Permanent Supplement, and hav com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worir 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 es are
required by the Act. The undersigned agrees to employ only such sub-contractors, on .' k to be performed under this permit, KS are
licensed by Miami Shores Village.
•
L40#S Sub division2A16Lva.Q. =
21— Street- . ._..__. — ..._..._._ �_
.__ Repairs
(Shined)
No. of Stories
Master Plumber.
STATE OF FLORIDA, 1 ss.
COUNTY OF DADE. i
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowkdgments, personally appeared
to me well known, and who, being by me first duly swan, upon oath deposes and says that he is the - -- •-- •---- -• - -.- _ _.... —.
of the above described construction, that he has cansfully read the foregeilxg application, and that be did sign the same, and that all facts
therein by him stated are true.
M Commisaion Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be arcade Reds celaspsedus V mada nsesssmy by improper notice for inspection. or faulty
material and/or workmanship.
)q‘we
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 wo
' /,
Owners Name and Address.._ L
_ - L _ —" -, l / ._ !__ No.__ i' . -G<GZ- Street._ ,.
Registered Architect and /or Engin ____ -- _______ ---
Employing Plumber's Name _ - =- � �� _ ' ' No.- 1 ,'.2 -2 ? Street__,i_ L'___w_-------- -_� - --
Location and Legal Description Lot___--- - - - - -_ _ __ -- Block ---- -- _ -__ Subdivision ...... _ _______________
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.
Size Septic Tank
Feet of Drain Tile
STATE OF FLORIDA,
COUNTY OF DADE.
e
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
__Type of Tank
/ -
Amount of Perrnit --. - - - - -- � - c - --
_ - -�- � (Signed) __ -_ --
( Signed)
Date
Street
Repairs No. of Stories.
Capacity Gals
- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: —Well ._ d ' _- -___ -- � -�_ -- 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 5968, Compiled General Laws of Florida Pennanent 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.
My Commission Expires Notary Public, State of Florida
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
COMM.
LIST
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 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 wo
' /,
Owners Name and Address.._ L
_ - L _ —" -, l / ._ !__ No.__ i' . -G<GZ- Street._ ,.
Registered Architect and /or Engin ____ -- _______ ---
Employing Plumber's Name _ - =- � �� _ ' ' No.- 1 ,'.2 -2 ? Street__,i_ L'___w_-------- -_� - --
Location and Legal Description Lot___--- - - - - -_ _ __ -- Block ---- -- _ -__ Subdivision ...... _ _______________
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.
Size Septic Tank
Feet of Drain Tile
STATE OF FLORIDA,
COUNTY OF DADE.
e
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
__Type of Tank
/ -
Amount of Perrnit --. - - - - -- � - c - --
_ - -�- � (Signed) __ -_ --
( Signed)
Date
Street
Repairs No. of Stories.
Capacity Gals
- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: —Well ._ d ' _- -___ -- � -�_ -- 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 5968, Compiled General Laws of Florida Pennanent 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.
My Commission Expires Notary Public, State of Florida
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.