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CLOSETS
BATH
TUBS
SHOWERS
,-- LAVA-
TORIES
SINKS
SLOB
SINKS
LAUNDRY
TUBS
URINALS
CATCH :
fASIN.
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
... -
-.
( CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
Prr-
GREASE
TRAP
-- SOLAR
HEATER
DEEP
WELL
SPRKLR.
, SYSTEM
SWIM'S
POOL
/ y
f/r
cL
CONTR.
LIST
CHECK
`
A
Al
A ♦
.,�
Size Septic
Feet of
Nature
..
Tank /O t,D Type of
T an k_/ /1 .E�Q.L
of Tank or Drain Field
Size
from
of Soakage
Capac Gals. ,075
Drain Tile
of Water
1 " .. ° Q . Dist Feet
Well
Supply: City —Well.
Pit 612 €2
Amount of Permit
The undersigned
i'nder the Florida
plied with the provisions
performed under this
required by the
licensed by Miami
STATE OF FLORIDA,
COUNTY :OF DADE.
Before me, the
! � `m (Signed)
he 1
a: a al
contractors
on the
•
�'i
=mod - _ _
applicant for this building p \s does hereby certify that
Workmen's Compensation Act, being Section 5986, Compiled
thereof, and will require similar compliance from all
permit; and will post or cause to be posted for inspection'
Act. The undersigned agrees to employ only such sub - contractors,
Shores Village.
. ( Signed)
1
undersigned authority, a notary public, duly authorized to
P1
erstands and accepts his ob sons as `
Laws of Florida Perman -nt Suppl ent,
or sub - contractors employed by h
site of the work such public noti
on work to be performed under i;is
� '
oT /..:c .. .
bmg Inspector.
of labor
com-
to be
as are
as are
employer
and has
in the work
or notices
permit,
administer
oaths and take acknowledgments,
er Plumber.
ersonally appeared
Employing Plumber's Name
Location and Legal Description Lo
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for ' • e building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shoes 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 'e Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specificati `. must be kept, at
building during progress of work. ,; �� 4
Owner's Name and Address �' '�"�' , No / SS ° A.
Registered Architect and /or. Engineer
No 0 ' 36 / 4 ' ' ! ` Stree
Street and Number where work is to be performed -No Street
1 - a
fate work to be performed and purpo se of building (By Floors
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 sam , and that all facts
therein by him stated are true.
My Commission Expires
Block Subdivisi
Date 3 -
Notary Public, State of Flo
a' 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 worlan
fli
Df
I
a
for
er
ion
Lot
Bl.
Subdi-
vision
of
Value of
Project
$
Amt. of
Permit
$
MIAMI SHORES VILLAGE, FLORIDA
BUILDING
ELECTRICAL
PLUMBING
Owner
Buildin
Archite
Contrac
or Build
Legal
Descrip
Addres
Buildin
C(INTR ACTOR OR BUIILDER
PERMIT N° 9078
Work to be performed under this Permit
DATE 195
Contractor's
License No.
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the 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 builder 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.
Signed • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY