685 NE 97 St (5)+_—
CLOSETS
BATH
Tuns
SHOW[Rn
LAVA.
TORIES
aINKO
SLOP
SINKS
LAUNDRY
Tuna
U RINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'N•
TOTAL
FIXTURES
CONTR.
LIST
CHECK
_
a
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
BPRKLR.
SYSTEM
SwIM
POOL
CONTR.
LIST
��-
CHECK
Permit No 1 fC'
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. .��� A.
Owners Name and Address Az . --7. -
Registered Architect and /or En
and Legal Desctipti .�� 81o1i l e/ Sub
Street and Number where work is to be performed -No Le 85"
Street . 22 ._... .
State work to be performed and purpose of building (By Floors) - --x-1 - -- -°• -mot
New Building________ . Remodeling___......_._____ Addition.. " Repairs
Size Septic Tank— _Type of Tangy
Feet of Drain Tile Dist Feet of Tank or Drain Field from Well. -.__.
Nature of Water Supply: City -We1L Size of Soakage Pit
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(signed)_ t(
(SI
Date..._ - -_ -_ 4 / //
Notary Public. State of Florida
No i.P O street..V I 1 •
No. of Stories ..........
_._.__._._. .... _...-__-..Capacity Gsls..._..._._.__ _._..._
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 Worlanen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and Ilrr cam-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the woe( to be
performed under this permit; and will post or cause to be posted' foe 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- coatr k to be per 't, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, I
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.
NOTE: A re- inspection fee of $1.00 will be wade wham snob ariaspeotiam V m dtr'asowaary by improper nodal, fer Inspection, at faulty
materials and /or workmanship.