8068MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING NKAIT
J
2 $
Permit No.__..__. Co el Datei
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 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 work.
Owner's Name and Address/P*K J Mi � , P�J-15 0 Street /
Registered Architect and/or Engineer f2Y /9t , /� /f�AA �e
Employing Plumber's Name `I ✓ �/ ' ` ! 'Vi No..� �.� �f ' / e
Block._._ Subdivision.
Street and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors) F
New BI Ming Remodeling Addition_ Repair's_ No. of Stories —
Location and Legal Description Lot
Size Septic T Type of Tomb
Feet of Drain Tile_ mist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit_
gide
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands
under the Florida Workmen's Compensation Act, Ding Section 5966, Compiled General
plied with the provisions thereof, and will require similar compliance from all
performed under this permit; and will post or cause to be posted' for inspection on
required by the Act. The undersigned agrees to employ only such sub -con
licensed by Miami Shores Village. .
.Capacity Gals.
umbing i .. tor.
and accepts his obli _ <. • ons as an employer of labor
of Florida Permanent Supplement, and has cam-
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon* oath deposes and .says that he is the
of
therein above are construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
t
M Commission Expires Notary Public, State of Florida
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 workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
KS SLOP
SIN
LAUNDRY
TUBS
. URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
Comm.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING NKAIT
J
2 $
Permit No.__..__. Co el Datei
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 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 work.
Owner's Name and Address/P*K J Mi � , P�J-15 0 Street /
Registered Architect and/or Engineer f2Y /9t , /� /f�AA �e
Employing Plumber's Name `I ✓ �/ ' ` ! 'Vi No..� �.� �f ' / e
Block._._ Subdivision.
Street and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors) F
New BI Ming Remodeling Addition_ Repair's_ No. of Stories —
Location and Legal Description Lot
Size Septic T Type of Tomb
Feet of Drain Tile_ mist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit_
gide
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands
under the Florida Workmen's Compensation Act, Ding Section 5966, Compiled General
plied with the provisions thereof, and will require similar compliance from all
performed under this permit; and will post or cause to be posted' for inspection on
required by the Act. The undersigned agrees to employ only such sub -con
licensed by Miami Shores Village. .
.Capacity Gals.
umbing i .. tor.
and accepts his obli _ <. • ons as an employer of labor
of Florida Permanent Supplement, and has cam-
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon* oath deposes and .says that he is the
of
therein above are construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
t
M Commission Expires Notary Public, State of Florida
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 workmanship.
BUILDING
ELECTRICAL
PLUIVIBING --
0
Owner of
Bu__ildin
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N?
8068
Contractor's
Licensee No
Work to be performed under this P ermit
Architect
Contractor
or Builder _ �; }ry y �A =4
Legal Lot II Bi Subdi-
Description
vision
Sq. lot
Value of Amt. of
Project $ Permit
This permit is granted to the contractor or budder named above to construct the budding or to install the uipment or device descri ed.in ,tlxe application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked ' at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or budder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. ' , . ; r
Signed' o mt,. ti k
rig ' -
INSPECTOR
I n consideration -of the issu a t m e of this permit I agree to perform the work covered herei ider in -
-. _ compliance- with all ordinances and regulations
pertaining thereto and in r 'et co ¢ o "ty with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit e, reap '. - ,bility for all work done by either, myself, my agent, servant or employee.