19765......,
CONTR•
CLOSETS
......••■•■
BATH
Tue.
SHOWERS
LAVA.
Toms
SINKS
Ewer
sows
LAUNDRY
Tu•.
umikus
111
•■•••.•••.....
Got?:
...............■
O U PI NI IN N:
•■■,....m...
................
TOTAL
FIXTURES
...................
..................■
LIST
CHECK
cowl,.
LIST
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
/SOLAR
H ATE
- -
WELL
SPRKLN•
SYSTEM
EVIM•O
POOL
............,
5.00
5.00
CHECK
4
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
19765
10/31/77
Permit
Application is hereby made for the approval of the detailed statement of the plans and specifications herewi h submitted for the building or other
struOture herein described This application is made in compliance and conformity with the Building �dInane 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 an4 regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved p1an and specifications must be kept at
building during progress of work.
Owner's Name and Address Miami Shores Presbyterian Church Na st and Park PlaceL.
Registered Architect and/or Engineer
Employing Plumber's Name HAR Na. Fla
Location ph& Desaiption Le Blot& Subdividon
Street and Ntunber where work is to be performed—Nol E St • . & Park Pl.s&s_ street. Parkins...LA
State work to be performell and purpose of building (By Floors) Well and irrigation system
New Building — Remodeling— Addition. Repairs-- . . ...... No. of Stories... .......
Size Septic Tank_— Type of Tank
Feet of Drain Tile--- --Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Wall _Size of Soakage Pit
Amount of Permit 4 10.00
.1.1*MT
(signed)
—Capacity Gals—___.—
The undersigned applicant for this building permit does hereby certify that he understands and accepts s obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida nanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-oontractors 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-contractors, to be performed under this permit, as are
licensed by Miami Shores Village.
Plumbing Inspector.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. I
Before me, the undersigned authority, a notary public, duly, authorized to administer cedes and take aclmowledgments. personally appeared
IC' d fea. j Cd e,
to me well known, and who, being by me first duly sworn, upon oath deposes and at • be is the
of the above described construction, that he bas carefully read the foregoing tfrat be did sign 1 - same, and that all facts
therein by Iiira stated are true.
N otary Public, State of florida at Large
My Commissiart.Expirnslunai0,1929--.
My Commission Expires
NOTE: A re-inspection fee of $1.00 will be made when such so4nspeotitas is stads neoossary by mproper notice for inspection, or faulty
materials and/or worlananship.