540 NE 96 St (12)-'��• u
CLOSRS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URL
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'O
POOL
CONTR.
LIST
_.
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of tc>, ;plans and specifications herewith submitted for thebuilding or other
structure herein described. This application is made in compliance and conc. :• `q with the r` lilcling Ordinance of Miami Shores Village, Florida,
and ail provisions of the Laws of the State of Florida, all ordinances of Miami S,,ores Vivag: 1.3d all rules and regulations of the Building Division
of Miami Shores Village shall be cr,zaplied with, whether herein specified ^ • rr2. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner'3 Name and Address_ �
Registered Arch tect and /or Engineer
Employing Plumber's Name._
Location and Legal Description Lot.
Street and Number where work is to be performed —No , 3 ?'
State work '.o be performed and purpose of building (By Floors ) _
New Building Remodeling--- _----------- __ -___ Addition-- - - - - -_ ---- _____ -. Repairs No. of Stories.
Size Septic Tank
Feet of Draiirfelit41-_614.
Nature of Watts Supply: City —Well.
Amount of Permit $
FLORIDA,
ss.
t2UNTy' Cr DADE.
1>�y (.33n? mission Expires
MIAMI SHORES VIL"_t4,CiZ
PLUMBING INSPECTION DEPARTME;<
APPLICATION FOR PLUMBING
v _ _ 167 No. e*°- — .A1. street.__ .. s
Block_
(Signed)
(Sign
Date
Street__
Subdivision
Street
Tye Tank__ — Capacity Gals.
Df_ss(. Wet of Tank or Drain Field from Well
__Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen:: Laws
plied with the provisions thereof, and will require similar compliance from all con • : ctors or su
performed under this permit; and will post or cause to be posted for inspection o • the si e• of
required by 'die Act. The undersigned agrees to employ only such sub - contra ors, o . wo
licensed by Miami Shores Village.
Notary Public, State of Florida
Plumbing Inspector.
and accepts his obligations as an employer of labor
of Florida Permanent Supplement, and has com-
b -contra rs employed by him in the work to be
the or such pub ]i'E}Igtice or notices as are
r k t perrry�t u er this pennit, as are
1;eforc :sie, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
%veIl kno.vn, and who, being by me first duly sworn, upon oath deposes and says that he is the
f the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
theroin t,4, bi stated are true.
NJTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
*net.nialc and /or workmanship.