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Permit No. __ - '--- ---- -�
Application is hereby made for the approval of the detailed statement of the plans and specifications her th submitted for the building or othm
structure herein described. This application is made in compliance and conformity with the Building Or ni ce 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 an regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved and specifications must be kept at
building during progress of work.
Owner's Name and Address. (3
Registered Architect and /or Engineer ..
Employing Plumber's Name -- --
Location and Legal Description
Street and Number where work is to be -No
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By Floors)
New Building
Remodeling
.Addition-..—__ Repairs __- ....
_ -:. -_
_......Capacity
Size Septic Tank -Type of 'heir
Feet of Drain Tile._ __._ - Gist. Feet of Tank or Drain Field from Wel _
Nature of Water Supply: City -Well. Size of Soakage Pit.
(situ)
Plumbing Inspector.,
The undersigned app this building permit does hereby certify that he understands and `. i is his obligations as en employer of labor
under the Florida Workmen's Compensation Act, being Section 6888, 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 m 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 notico 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 an
Hemmed by Miami Shores Village.
(Signed)
Master plumber.
STATE OF FLORIDA, t s
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take - acknowledgments, personally appears*
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 aA fac
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or foul
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
:OOG
Owner of
Building
Architect
Contractor
or Builder
Legal = �� Subdi
Description, vision
Amt of
Permit $
Address of
Building
Value of
Project $
This permit is :granted to the contractor or builder nanied above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to - -the work covered- hereby wlietber shown -on the plans or drawings or in the statements or specifications and that he acmes _responsibility for work
done by his agents, servants or employees.
Signed
nasriirox
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the :plans, ; drawings, .'statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I ,assume responsibility for all work done by either, myself, my agent, servant or employee.