3654Permit No.__ L Date /
Application is hereby 'e for the approval of the detailed statement of the plans and spec ificatons 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 Miansi Shores Village shall be complied with, whether herein specified or not. A copy of appsoved plans .� ti must be kept at
building during progress of work. 6 17,
� � � /
Owner's Name and Address �� a"°O"""®� -' ` '' v 1'
Registered Architect and /or Engineer
•
Employing Plumber's Nam
Location and Legal Desaripti
Street and Number where work is t� be
State work to be performed and purpose of building (By Floors)
New Building r ode 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 Well. Size of Soakage Pit
Amount of Permit $ 1X r (Signed)
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 5966, 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 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
reMdred by the Act. The undersigned agrees to employ only such sub - contractors, • on work to be performed under this permit, as are
Boomed by Miami Village.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before ore, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
OS.
My C01111211010n Expires
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 all facts
therel n by him stated are true.
NOTE: A re- inspection fee of $LOQ will be made when such re- inspection is a +. by improper notice for inspection, or faulty
Materials and /or wtrkmansbip.
r
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Capacity Cats. _ ______ -
Notary Public, State of Florida
CLOSETS
BATH
TUBS
SHOWERS
RYA.
TORIES
OINKS
SLOP
SINKS
LAUNDRY
TUBS
VRt �
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR. .
L
CHECK
-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWI N•O
POOL
CHECK
___91_
Permit No.__ L Date /
Application is hereby 'e for the approval of the detailed statement of the plans and spec ificatons 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 Miansi Shores Village shall be complied with, whether herein specified or not. A copy of appsoved plans .� ti must be kept at
building during progress of work. 6 17,
� � � /
Owner's Name and Address �� a"°O"""®� -' ` '' v 1'
Registered Architect and /or Engineer
•
Employing Plumber's Nam
Location and Legal Desaripti
Street and Number where work is t� be
State work to be performed and purpose of building (By Floors)
New Building r ode 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 Well. Size of Soakage Pit
Amount of Permit $ 1X r (Signed)
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 5966, 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 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
reMdred by the Act. The undersigned agrees to employ only such sub - contractors, • on work to be performed under this permit, as are
Boomed by Miami Village.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before ore, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
OS.
My C01111211010n Expires
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 all facts
therel n by him stated are true.
NOTE: A re- inspection fee of $LOQ will be made when such re- inspection is a +. by improper notice for inspection, or faulty
Materials and /or wtrkmansbip.
r
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Capacity Cats. _ ______ -
Notary Public, State of Florida
4
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