11227. Permit No \
AP�LICA
I
1 ION FOR PLUMBING PERMIT y
Date
Application is hereby made for
structure herein described. This
and all provisions of the Laws
of Miami Shores Village shall
� a
building during progress o work.
Owner's Name and Address
the approval of t4
application is made
of the State of Florida,
1 e complied with,
!
detail
in compliance
all o
ether
-
d statement of the plans and specifications herewith submitted for the building or other
and conformity with the Building Ordinance of Miami Shores Village, Florida,
dinances of Miami Shores Village and all rules and regulations of the Building Division
specified
erein or not. A copy of approved plans and specifications must be kept at
Registered Architect and /or Engin
Employing Plumber's Name
Location and Legal Description
Street and Number where world
State work to be performed an
New Building__
'
-,
a - - a ;1-3--1 * a • No 4 e / Street. 2? • ;
L.
is to be performed
Block Su bdivisi
—No.
0 / Street ' '' 8 s _
purpose of building Q'By
Remodeling
Floors) ./ •1 "�. °'° -- 'l J 4 4�" `�* °�L
r
Addition Repairs!. No. of Stories
_
j
CLOSETS
BATH
TUBS
SH•WERS
LAYA_
TARIES
_ !
4 NKS
SLOP
SINKS
LAUNDRY -
TUBS
URINALS -
CATCH
BASIN
t LOOR
RAIN
TJRINKC;
FOUNT'
TOTAL
FIXTURES
CONTR.
LIST
-
I
1
-
-
-
CHECK
_
SEPTIC
- TANK
SEWER
-- CONN.
DRAIN
FIELD '
SOAKAGE
,. - -PIT
G REASE
- TRAP -
'. SOLAR
[
DEEP
WELL -
SPRKLR.
- SYSTEM
SWIM'G
POOL
-
-
_
CONTR.
1'
CHECK -
-
Size Septic Tank
ype of 4 Capacity Gals
Feet of Drain Tile
. . ,
Feet f of Tank or Drain Field from Well
Nature of Water Supply: City
-Well, '
Sire of Soakage. Pit
�
is �
% ��.
° it -4, d
I
Amount of Permit $�
b war ,
(Sign- . �' C
. O
The undersigned applicant
under the Florida Workmen's
with the provisions thereof,
for this built-ling .
Compensation Act, b
and will require
•
•. t d
=ing S
y u Compliance
Plumbing Inspector.
hereby certify that he ... - :3 : • ds and accepts his obligations as an employer of labor
on 5966, Compiled General Laws of Florida Permanent Supplement, and has con-
from all contractors or sub - contractors employed by him in the work to be
plied
performed
required by the Act. ct permit;
the h undersigned
licensed by Miami Shores Village.
cause
agrees to
authority, a notary
to be for inspection on the site of the work such public notice ; or notices as are
only such sub - contractors, on work to be performed under this permit, as are
1 i=sc" fi
•
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned
1 -
Mister Plumber.
il
i 11
public duly authorized to administer oaths ` and take acknowledgments, personally appeared
to me well known, and who, being
of the above described construction,
therein by him stated are true.
by me first duly sworn,
that he has carefully
____
iron oath deposes and says that he is the_—...-- __- :.__�_-_ _
read the foregoing application, and that he did sign •the same, and that fasts
My
sion Expires
Notary Public, State of Florida
NOTE: A re-inspection fee
materials and/or warkma na i I
of $LOO will be
I
1
-a.
Made when
d
such re- inspection is made nece ssary by improper notice for inspection,
i 1
or faulty
MIAMI SHORES VILLAGE
PLUMING INSPECTION DEPARTMENT
Subdi-
vision
BUILDING
cA PERMIT
PLUMBING
RoOFIN4 El Work to be performed
Owner of
Btu`1cding
von'
or -Solider
Leggy
Description.,„
Address of
Building
This permit is granted to the contractor or budder name
herefor in strict compliance with all ordinances pertaining th
drawings, statements or specifications that may have been submi
time if the work is not done in compliance with such ordinances
granted is the understanding that the contractor or builder nam
pertaining to the work covered hereby whether shown on the p
done by his agents, servants or employees.
Inconsideration of the issuance to me-of this permit I a ree to orm -the work covered hereunder in compliance -with all - ordinances and regulations
pertaining thereto and in strict conformity with the plans, ; drawwiun�gs, stat eMeents or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit - I assume responsibility for all work done by "Zither, myself, my agent, servant or employee.
- . MIAMI -S1-1
RE VILL.Af E FLORIDA
DA
Q 11227
er this Permit
Value of
Project $
above to construct the budding or to install the equipment or device described in the application
and with the understanding that the work will be performed in compliance with any plans,
to and approved by the proper municipal authorities. This Permit may be revoked at any .
r if the plans are changed without authorization. A further condition upon which this permit is
above assumes the responsibility for a thorough knowledge of the ordinances and regulations
or drawings",or in the ea ,or specifications and that he assumes'responalbility for work
/
Contractor's
License No
MINORITY
0 14