602 NE 96 St (9)/6
PP
• y
f.ONTR.
ji LIST
;CHECK
No
CLOSETS
SEPTIC
TANK
BATH
TUBS
SEWER
CONN.
SHOWERS
DRAIN
FIELD
11.
SINKS
SOAKAGE GREASE
PIT - TRAP
SOLAR
HEATER
DEEP
WELL
URINALS
Repairs
SPRKLR.
SYSTEM
SWIM'O
POOL
Dia
Type of Tank Pile •• C "T Capacity Gals
Feet of Tank or Drain Field from Well
Size of Soakage Pit
Itt
t 1 soma?
Fl: ta..) .Y - p,a.ro.
1
•
Ali 7
Lion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for • e building or .' er
e herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Sh. es Village, Florida,
ypd provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of • e Building Division
' Shores Village shall be complied with, whether: herein specified or not. A copy of approved plans and specifications must be kept at
during progress of
ddresss $ Te.IrA ay., l �
A to Ir a No Str
Architect and /or Engineer k'1rt11 '_ . C'[0 h°SQ_ i, itti w , , . -‘ 7... s jam&. ' .
a • ploying Plumber's NamMA t` I9 ., ` 6 ®'e t 4 No 4 Sir
tOnd Legal Description Lot< l ' I O 1 . -04 ,"0 Block � Subdivision_
trot an. umber where work is to be performed —No., i0 i . • 'v.?'° Roe LA ie se Str ut • g ►t
1 O NTR
LI8T
iCHECK
•
og) to be perf and purpose` of building (By Floc s )
Remodeling Addition.
Size - Septic Tank
Feet of Drain Tile
Nature of Water Supp
Amount of Permit $
LAVA.
TORIES
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
SLOP
SINKS
LAUNDRY
TUBS
(Signed)
•
CATCH
BASIN
Date
FLOOR
DRAIN
TATE Off! FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments;;
DRINKING
FOUNT'NS
No. of Stories L-
4� -
P hmbing ispector.
The undersigned applicant for this building permit • oes ereby - • fy he understands and accepts his obligations as employer of la
Under the Florida Workmen s Compensation Act, being Section 5986, Compiled' General Laws of Florida Permanent Suppleaent, and has
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors ein y • by hi>r► in the work to be
berformed under this permit; and will post or cause to be posted for inspection on th of the work suc, ;pub a noti ce or notices as are
required by the Act. The gned agrees to employ only such sub -contr ors, o/P ork to be, pe grin:. ' and vs permit, as are
licensed by Miami Shores Village,
to me well ]moan, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above describe construction, that he has carefully read the foregoing application, and that he dad sign the sam4, and that all facts
therein by him stated are true:
My Commission Expires Notary, Public, State of Florida
TOTAL
FIXTURES
NOTE: A re inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workrnanship.
a.:mutual trotection to ctiei ts..tbe '.. �ltc.:and:ouraclvss: :all: reports; are,submltted s;:the.r
pt blteaftoi of statenleats,; conclusions `or eztracts 9? rs9ai+ding ou= :