7088c„,Q,0
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING E' MIT
Permit No Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewi 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 plans and specifications must be kept at
building during progress of
Owner's Name and Addr
Registered Architect and /or Engineer
Employing Plumb's Name
Str
'Li 2?
Street
Location and Legal Description Lot Bkr'
Street and Numb where work is to be performer) --No Street
State work to be performe8 and purpose of building (By Floors)
New Be holing Remodeling Addition Repairs _ ___ .... _ No. of Stories...
Subdivis[o'+
Size Septic Tank � Type of Tenn /
D Feet of Drain Tile_. 3 f /44, mist. Feet of Tank rain Field from Well_
Nature of Water Supply: City Well eke of Soakage Pit
(Signed)
_Capacity Gals.—_____
"Pr r
Amount of Permits .. (Signed)
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 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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shares Village.
to me wen known, and who, being by me first duly sworn, upon oath deposes and.says that he is the
of above stated are true.
construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fa
STATE OF FLORIDA,
COUNTS OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State, of Florida
a
NOTE: A a r wor on fee. of $1.00 will be made when snob re-inspection is made'neeessary by improper notice for inspection, or faulty
materials
CLOSETS
BATH
TUBS E
SHOWERS
LAVA.
TOR1E6
SINKS
SLOP
SINKS
LAUNDRY
TUBE
...... L6
- CATCH
BABIN
FLOOR
DRAIN
DRINKING
FOUNT NB
TOTAL
FIXTURES
CONTR.
LIST
_�_
CHECK
awns
TANK
- " SEWER
CONN.
DRAIN
FIELD
SOAKAGE.
P1?
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHECK
c„,Q,0
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING E' MIT
Permit No Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewi 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 plans and specifications must be kept at
building during progress of
Owner's Name and Addr
Registered Architect and /or Engineer
Employing Plumb's Name
Str
'Li 2?
Street
Location and Legal Description Lot Bkr'
Street and Numb where work is to be performer) --No Street
State work to be performe8 and purpose of building (By Floors)
New Be holing Remodeling Addition Repairs _ ___ .... _ No. of Stories...
Subdivis[o'+
Size Septic Tank � Type of Tenn /
D Feet of Drain Tile_. 3 f /44, mist. Feet of Tank rain Field from Well_
Nature of Water Supply: City Well eke of Soakage Pit
(Signed)
_Capacity Gals.—_____
"Pr r
Amount of Permits .. (Signed)
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 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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shares Village.
to me wen known, and who, being by me first duly sworn, upon oath deposes and.says that he is the
of above stated are true.
construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fa
STATE OF FLORIDA,
COUNTS OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State, of Florida
a
NOTE: A a r wor on fee. of $1.00 will be made when snob re-inspection is made'neeessary by improper notice for inspection, or faulty
materials
- _i