19223MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No....1-.. f.W Date
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 Budding 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 plans and specifications must be kept at
building during progress of work.
,cl
Owner's Name and Address
Regz:r ed Architect E /U i ,(1,i %'�'1 .�r./
Location and Legal Description Lot /.-
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.--
Amount of Permit $
Type of Tank
of
(soma)
7 Gals...
(shin) ," 4
2
Size Septic Ti*ti
Feet of Drain Tile_ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —W
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 5988, 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 bier in the work to be
performed under this permit; and will post or cause to be posted far inspection on the site of the work such public notice or notices as are
required by die required by Miami S. The undersigned a to employ only such sub- contractors, on work to be ,- i -. r as are
STATE OF FLORIDA, I ss.
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acloaowledgo>ests, personally appeared
to me well known, and who, being by me first duly swam, upon oath deposes and says that he is the_ . __ ..
of the above described construction, that be has carefully rend the regcing application, and that hs _ sign the same, and dui a l fads
therein by him stated are true.
My Commission Expires Nobly Public, State of Flodda
NOTE: A re- inspection fee of $IAO will be made whoa we a le paodou 1s maruso —, by Improper notice for inspection, or faulty
materials and/or wodmssoahip.
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MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No....1-.. f.W Date
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 Budding 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 plans and specifications must be kept at
building during progress of work.
,cl
Owner's Name and Address
Regz:r ed Architect E /U i ,(1,i %'�'1 .�r./
Location and Legal Description Lot /.-
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.--
Amount of Permit $
Type of Tank
of
(soma)
7 Gals...
(shin) ," 4
2
Size Septic Ti*ti
Feet of Drain Tile_ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —W
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 5988, 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 bier in the work to be
performed under this permit; and will post or cause to be posted far inspection on the site of the work such public notice or notices as are
required by die required by Miami S. The undersigned a to employ only such sub- contractors, on work to be ,- i -. r as are
STATE OF FLORIDA, I ss.
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acloaowledgo>ests, personally appeared
to me well known, and who, being by me first duly swam, upon oath deposes and says that he is the_ . __ ..
of the above described construction, that be has carefully rend the regcing application, and that hs _ sign the same, and dui a l fads
therein by him stated are true.
My Commission Expires Nobly Public, State of Flodda
NOTE: A re- inspection fee of $IAO will be made whoa we a le paodou 1s maruso —, by Improper notice for inspection, or faulty
materials and/or wodmssoahip.