15735MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 5 Date 7 -29 -73
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.Dtvision
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.
Owner's Name and Address...._. Bros. —Miami Shores Psbvterian Chia
Registered Architect and /or Engineer
Employing El bo€'s Name— Rose Septic Tank Co. am 1 P.O.Box G4 '' aleah __
... .'... �aeds eaax:tdee!e•..
Location and Legal Description Lot Bblv& Subdivision
Street and Number where work is to be performed —No 602 N . E 2 96th .streeitreet
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Addition._ Repairs._. . No. of Stories. ......
Size Septic Tonle Type of Tank
Feet of Drain Tile nisi. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Si" of Soakage Pit
Amount of Permit $ 5 (Signed)
STATE OF FLORIDA, 1
COUNTY OF DADE. j
(Signed)
Caadty Gals.__.
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 Workmen's Compensation Act, being Section 5960, 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 p employed n by him or 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 motive or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed tinder this permit, as are
licensed by Miami Shores Village.
sea
Master Phmnber.
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 fonsgoing application, and that he did sigh the same, acct that all Facts
therein by him stated are true.
M y Colon Expires Notary Public, State of Florida
materials EE: A re- i on fee of $1.00 will be made when each r inspection is ma�•neoessary by improper notice for , or faulty
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MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 5 Date 7 -29 -73
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.Dtvision
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.
Owner's Name and Address...._. Bros. —Miami Shores Psbvterian Chia
Registered Architect and /or Engineer
Employing El bo€'s Name— Rose Septic Tank Co. am 1 P.O.Box G4 '' aleah __
... .'... �aeds eaax:tdee!e•..
Location and Legal Description Lot Bblv& Subdivision
Street and Number where work is to be performed —No 602 N . E 2 96th .streeitreet
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Addition._ Repairs._. . No. of Stories. ......
Size Septic Tonle Type of Tank
Feet of Drain Tile nisi. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Si" of Soakage Pit
Amount of Permit $ 5 (Signed)
STATE OF FLORIDA, 1
COUNTY OF DADE. j
(Signed)
Caadty Gals.__.
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 Workmen's Compensation Act, being Section 5960, 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 p employed n by him or 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 motive or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed tinder this permit, as are
licensed by Miami Shores Village.
sea
Master Phmnber.
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 fonsgoing application, and that he did sigh the same, acct that all Facts
therein by him stated are true.
M y Colon Expires Notary Public, State of Florida
materials EE: A re- i on fee of $1.00 will be made when each r inspection is ma�•neoessary by improper notice for , or faulty