370 NE 97 St (7)Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building OT 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 mud be kept at
building during progress of work.
Owner's Name and Address Dean C1aussen No.__ 3 70
Registered Architect and /or Engineer
Employing Plumber's Na Brooks- American Co . N o. 2 0 N.T , Z th St eel
lineation and Legal Description Lot.
Street and Number where work is to be perform —No
State work to be performed and purpose of building (By FlzEaro) __..---- ....---- .-- •.--- ___._._
New Building Remodeling ____._ _ _ Addition. Repairs No. of Stories
r te._
COCSTR.
LIST
CHECK
Amount of Permit $ 16.00
NOTE: A re-inspection fee of On
mataiala and /or workmanship.
My Conanniaaion F., s
Q�t
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
L.AUNDR
YUXS
�a�sA
WLLL
Block Subdivision.._..._.....__.__ 370 Street. N . E . 97t
URINALS
CATCH
BASIN
Sine Septic of Teal:—
Feet of Drain Tile._ - _—_ — _ _Dist. Fes e 5 aaa or Drain Field from Well
Nature of Water Supply: City — Wall.------- _ -___ -- ------- -.S4ze of Soakage Pit
FLOOR
DRRIN
Date. - - `1t Y_ _ �_ t ' � g75) . _
DRINKING
FOUNT'NO
SFRKLR.
SYSTEM
8.00 8.0C
5w 1 0
POOL
Capacity Gals.
F u'mbing Inspector.
The undersigned applicant for this building p�.,rrs:it does heenby certify that one understands and accepts his obligations /s a employer of labor
under the Florida Workmen's Compensation Act, being Section 5963, Compiled General Laws of Florida Permanent Sup,i . ent, and has come
plied with the provisions thereof, and will require thi ii r compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cake to be ported' for inspection on the site o the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on w rIt to be perfosd urd rmit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, t
COUNTY OF DADE. b
Before me, the undersigned authority, a notary ygu'ol duly urse�amined to administer oaths and take acksnowledgntenis, personally appeared
to me well known, and who, being by arse first duly sworn, tip even doses and says that he is the ............... .... ... _ ....._ _..
of the above described construction, that be has carefully nnni Ben oregaing application, and that he did e...4 the same, and that all facts
therein by him stated are true.
Notary ?uble, Elate of E art'' a
Mister Plumber.
evil be =do c tn3- is raarferneocratry by improper notice for inspection, or faulty
TOTAL
FIXTURES
_..,_.....—...
CLosaTo
BATH
TUBS
SHCIWER6
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
L IST
CHECK
—
-...-
......m■
...
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM' G
POOL
Cotrrn.
LisT
CHECK
_
Permit Ne
Owner's Name and Address Dean Claussen
Registered Architect and/or Engineer
Employing Plumber's Name
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By
New Building Remodeling
Amount of Permit 0._ _,L
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
PLAT
k PLUMBING PERMIT
Aug. 11th, 75
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.
O'Neal Septic Tank Co.
Location and Legal Description Lot_ Block
No_370 street__ 92 .....
...... -
No_ P
Street-- "Vialflt; " 33144
Subdivision________ ....... .........
370 .61.i1;0
Floorsj___
Addition Repairs
Street 9.7th
STAB Septic Tank_ 9_0_0_ gal.._ Type of Tank_
Feet of Drain Tile 300 5cL. ft. _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well Size of Soakage Pit
( Signed)_
(Signed)._
Capacity Gals...
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obIjgtlons 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 pennit; 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.
No. of Stories. _ _
Notary Public, State of Florida
'' Plumbing Inspector.
Master Plumber.
STATE OF FLO r
as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well lmown, 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•neeessary by improper notic3 for insr '1, or faulty
materials and/or workmanship.
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
made for the approval of the detailed statement of the plans and specifications herewith submitted for the building ? '' r :. ii
Date..._.._ ` ./..
__ . d
Permit No � ., --- -.-- -�.— .. . ._ _..._ _.
Application is hereby n ppro p aped ding m 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 o � 4 - gL No.
Registered Architect and /or En
Employing Plumber's Name. :,.,,., :.�- .t:— :i+:� - - -=-i
Location and Legal Description L6t- , a ';
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By
Remodeling
Nes tuilding ..
,... No,, ,. .,,,.e....m..,....�.,..,,.. Street......
,.., `CYO'
Block Subdivialon.._.__._.___...
!reef_
Floors )-- ..,%. :,_ =
Size Septic Tank— .— •--- - - - - -- -- — - -_— _...Type of Tank__
Feat of Drain Tile. _ — — __- _Dist. Feet of Tank or Drain Field from Well..._
Nature of Water Supply City— ell -- _----- -___ -- - -- - -- •_Size of Soakage Pit
Addition..._..._ Repairs No. of Stories.. �.......
(Sign«
Capacity Gals
lumbii g tor.
The undersigned applicant for this building permit does bereby certify that he understands and accepts his obligat as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Pennanent upplement, and Ilan com-
plied with the provisions thereof, and will require similar ccirpliance 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.
/ 3 c ( Si
C
My Commission Expires 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 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 tore.
NOTE: A re- inspection fee of 81.00 will be made when mob rs4nspectfoo L made'neoemary by improper notice for inspection, or faulty
materials and /or workmanship.
URINALS
CATCH
imam
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CLossis
BATH
TUBS
SHOWIER•
LAVA-
TORIES
SINKS I
G LOP
SINKS
LA
TUBS
C LIST
-7 -
/
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAOI
PIT
GREASE
TRAP
afaiPSS
HEATER
DI'
WILL
SrRKLR.
SYSTEM
SWIM'O
POOL
ph
CONTR.
�J'
6
-
..
CHICK
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
made for the approval of the detailed statement of the plans and specifications herewith submitted for the building ? '' r :. ii
Date..._.._ ` ./..
__ . d
Permit No � ., --- -.-- -�.— .. . ._ _..._ _.
Application is hereby n ppro p aped ding m 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 o � 4 - gL No.
Registered Architect and /or En
Employing Plumber's Name. :,.,,., :.�- .t:— :i+:� - - -=-i
Location and Legal Description L6t- , a ';
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By
Remodeling
Nes tuilding ..
,... No,, ,. .,,,.e....m..,....�.,..,,.. Street......
,.., `CYO'
Block Subdivialon.._.__._.___...
!reef_
Floors )-- ..,%. :,_ =
Size Septic Tank— .— •--- - - - - -- -- — - -_— _...Type of Tank__
Feat of Drain Tile. _ — — __- _Dist. Feet of Tank or Drain Field from Well..._
Nature of Water Supply City— ell -- _----- -___ -- - -- - -- •_Size of Soakage Pit
Addition..._..._ Repairs No. of Stories.. �.......
(Sign«
Capacity Gals
lumbii g tor.
The undersigned applicant for this building permit does bereby certify that he understands and accepts his obligat as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Pennanent upplement, and Ilan com-
plied with the provisions thereof, and will require similar ccirpliance 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.
/ 3 c ( Si
C
My Commission Expires 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 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 tore.
NOTE: A re- inspection fee of 81.00 will be made when mob rs4nspectfoo L made'neoemary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No.. -__((
Amount of Permit $ 47,50
STATE OF FLORIDA,
u.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
fiRS Pprmy •f - SP ° 3130
31dg..1 mit :28354.
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 ce not. A copy of approved plans and specifications must be kept at
building during progress of work.
CiaUSSr?n
Kr- -k1 ` p�
Owner's Name and Address No � -' �® Street,✓ —� ���d%"'
Registered Architect and /or Engineer
Employing �luts nmQ R o y n S A p t z c Tank nk Co. 887-55 %,..„
.., . �...��..�.�....�.. i t.2 • •- su
Y,o �� �a�`�kssti ' 3�b « 1—i a o F 1_ 30 , �—' ,.,
as Le ption Lot. ldIos�ll Subdivision
Street.
Street and Number where work is to be performed —No 3711 N o 97 rA {,
State work to be performed and purpose of building (By Floors)_—__
New Building.._-._. -..- - - Remodeling __ ____ Addition..._- __..__ Repairs No. of Stories
Size Septic Tank_ I fl50 g a s. Type of Tonic C O 1 C T p t
Feet of Drain Tile 5(lr1 S a' f `' • Dist_ Feet of Tank or Drain Field from Well ..-_ --.._ —
Nature of Water Supply: City —Well. Size of Soakage Pit.
Plumbing Inspec
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 Permanent Supplement, and Ilur 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 es 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.
(Signed)
Before me, the undersigned authority, a notary public, duly authorized to administers and ta�ceac7ciwwledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says
of the above described construction, that he has carefully read the foregoing app
therdn by kizicAleiltPfkiulttIMItTE OF FLORIDA
NY COMMISSION EXP. APR. 3,1992
ff 91t6�8'tffil�'�+`
NOTE: A re- inspection fee of $1.00 will be male what molt nispeotlon is made•
materials and /or wod®aaship.
(Signed) A i 1rG - = - - - ._._....
is the.
Date. - ---.-
Master Plumber.
and that he did sign the • . and that all facts
Notary Pubdio, State of
cemetery by npeopar notice fors ! specflon, or faulty
CLOSETS
BATH
TUS•
SNO,a,„
LAVA•
TORIES
11"4"
SLOP
SINKS
LAUNDRY
TU.s
URINALS
CATCH
SAWN
FLOOR
DRAIN
DRINKING
FOUNT' N•
TOTAL
PIETURe•
CONTR.
LIST
CHECK
_
SEPTIC
TANK
SEWER
CONN.
DRAIN SOAKAGE G
FIELD PIT TRAP
SOLAR DEEP
HEATER WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
I !
Co.. TR
LIST
1.'T
0 ga1s.W5f0 Sg,ft.
22.5'
�—
CHECK
PO &
/- garcon o
25.0(`
Permit No.. -__((
Amount of Permit $ 47,50
STATE OF FLORIDA,
u.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
fiRS Pprmy •f - SP ° 3130
31dg..1 mit :28354.
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 ce not. A copy of approved plans and specifications must be kept at
building during progress of work.
CiaUSSr?n
Kr- -k1 ` p�
Owner's Name and Address No � -' �® Street,✓ —� ���d%"'
Registered Architect and /or Engineer
Employing �luts nmQ R o y n S A p t z c Tank nk Co. 887-55 %,..„
.., . �...��..�.�....�.. i t.2 • •- su
Y,o �� �a�`�kssti ' 3�b « 1—i a o F 1_ 30 , �—' ,.,
as Le ption Lot. ldIos�ll Subdivision
Street.
Street and Number where work is to be performed —No 3711 N o 97 rA {,
State work to be performed and purpose of building (By Floors)_—__
New Building.._-._. -..- - - Remodeling __ ____ Addition..._- __..__ Repairs No. of Stories
Size Septic Tank_ I fl50 g a s. Type of Tonic C O 1 C T p t
Feet of Drain Tile 5(lr1 S a' f `' • Dist_ Feet of Tank or Drain Field from Well ..-_ --.._ —
Nature of Water Supply: City —Well. Size of Soakage Pit.
Plumbing Inspec
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 Permanent Supplement, and Ilur 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 es 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.
(Signed)
Before me, the undersigned authority, a notary public, duly authorized to administers and ta�ceac7ciwwledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says
of the above described construction, that he has carefully read the foregoing app
therdn by kizicAleiltPfkiulttIMItTE OF FLORIDA
NY COMMISSION EXP. APR. 3,1992
ff 91t6�8'tffil�'�+`
NOTE: A re- inspection fee of $1.00 will be male what molt nispeotlon is made•
materials and /or wod®aaship.
(Signed) A i 1rG - = - - - ._._....
is the.
Date. - ---.-
Master Plumber.
and that he did sign the • . and that all facts
Notary Pubdio, State of
cemetery by npeopar notice fors ! specflon, or faulty
ti
1.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date.. ----- � -a f -• - -...— —
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.
Permit No
Owner's Name and Address Avg 4-€4
Registered Architect and /or Engineer
Employing Pl bor's e ._. -� - q 1 Co I.I I rj
Eml
// Loos i and / Legal� p tion l v
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.
Amount of Permit i (P`
My Commission Expires
(Signed)
3 70
No. 31
( S i g n e d ) —
Street.._ I£ C, t"
Subdivision.... —.
stree f
t_. ._..- �- �-- �- - -•• -9 � � .
Repairs No. of Stories / .. .....
Size Septic Tank_-_ _Type of Tanfr
Feet of Drain Tile. _________Dist Feet of Talc or Drain Field from Well ...-. -
Nature of Water Supply: City—Well _I___ 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 Permanent Supplement, and WV mm-
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 - contractors, on work to be performed under this permit, es are
licensed by Miami Shores Village.
6 e ,‘ el Master Plumber.
STATE OF FLORIDA, 1 µ
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 he has carefully read the foregoing application, and that be did sign the ame, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when Snob misspaottan ie made aeoseetry by improper notice for Inspection, at fanky
materials and /or workmanship.
CLOERa
BATH
TUGS
SNOW[RS
LAVA.
TORIES
SINK.
SLOP
SINKS
OR T
LAUN Tua•
URINALS
C TC KI
BAASIN H
FLOOR
DRAIN
ORIN NO
FOUNT'NS
TOTAL
"'Ellin".
-
CO NTK •
_
Z
y
(
CN[CK
I 6
I
72
—
SEPTIC
TANK
SEWER
CONN.
DRAIN
PI[LD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DRIP
WELL
BPRKLR.
a
awim'a
POOL
I -
CONTR.
LIST
r-
CHECK
ti
1.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date.. ----- � -a f -• - -...— —
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.
Permit No
Owner's Name and Address Avg 4-€4
Registered Architect and /or Engineer
Employing Pl bor's e ._. -� - q 1 Co I.I I rj
Eml
// Loos i and / Legal� p tion l v
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.
Amount of Permit i (P`
My Commission Expires
(Signed)
3 70
No. 31
( S i g n e d ) —
Street.._ I£ C, t"
Subdivision.... —.
stree f
t_. ._..- �- �-- �- - -•• -9 � � .
Repairs No. of Stories / .. .....
Size Septic Tank_-_ _Type of Tanfr
Feet of Drain Tile. _________Dist Feet of Talc or Drain Field from Well ...-. -
Nature of Water Supply: City—Well _I___ 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 Permanent Supplement, and WV mm-
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 - contractors, on work to be performed under this permit, es are
licensed by Miami Shores Village.
6 e ,‘ el Master Plumber.
STATE OF FLORIDA, 1 µ
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 he has carefully read the foregoing application, and that be did sign the ame, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when Snob misspaottan ie made aeoseetry by improper notice for Inspection, at fanky
materials and /or workmanship.