650 NE 97 St (8)•
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'S
POOL
CONTR.
LIOT
CHOCK
n _
ermit No - 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 �y �/
Owner's Name and Address._.4C./__ ® AY �j��lY.'_... No.__- _.. - - -_ Street
Registered Architect and /or Engineer
Employing Plumber's Name. __ /G /9i..gA__.__5FX �� �1/L1r K144No.__ _._____ —_._ Street.
Location and Legal Description Block_ Subdivision
Street and Number where work is to be performed —No r5 � ql Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Size Septic Tank / ______Type of Tank
Feet of Drain Tile________?__�t, ._- _.- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well .____ _ __._._________.__Size of Soakage Pit
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOP PLUMBING "' b9,MIT
Addition__._._._. — Repairs No. of Stories..
f 5,T
(Signed)-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige
under the Florida Workmen's Compensation Act, being Section 5963, Compiled General Laws of Florida Perinan
plied with the provisions thereof, and will require similar compliance from all contracto ors b -con
performed under this permit; and will post or cause to be posted for inspection on th site the
required by the Act. The undersigned agrees to employ only such sub- contractor , on k
licensed by Miami Shores Village.
(Signed)
Capacity Gals..
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 true.
My Conunission Expires Notary Public, State of Florida
g Inspector.
ployer of labor
ent, and bus coin-
him in the work to be
ce or notices as are
this permit, as are
Master Plumber.
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.