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41111101.16
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Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.. kr9 2- Date...5 2 3
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 plane and specifications mud be kept at
building during progress of work.
Owner's Name and Addresabd.:0 05/er 0_1 Pre'Spc/2440 '4 1.4S h stree ,..14_ , 0,1 4,41144.
Registered Architect and/or Engineer 44./Ap.
EmploYing Plumber's Neancaitatit,,S , ale"' I 1 ,1 Na, . Itnet.44444:
Location and Legal Description Lot—
81o4 SuMvWcn._.
Street and Number where work is to be performed—No. Streeti4'_4_44 V 4.
State work to be performea and purpose of building (By Floon)
New Building
Remodeling— Addition. Repairs_...... .. ..... No. of Stories.......... . .
Size Septic Tank Type of Teel:
Feet of Drain Tile— That. Feet of Tao* or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit.
(Signed)
...Capacfty .
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 5900, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in 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 notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-oontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 thregohqg application, and that he did sign the same, and that all facts
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-inspectiun is neadreecessary hnproper notice for inspection, at faulty
mateaials and/or workmanship.
Master Plumber.