PLUMBINGdd"liami cShores
F L H I D A
PLUMBING PERMIT
f
to install the following described plumbing, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
/ building g a c2.1
For a ;/ story
Fixtures
Fixtures
Sewer
tic Tank
$
$
Total $
Village Plumbing Inspector
Received Payment by
N9 1123
with the laws, statutes and regu-
Florida, governing plumbing and
/ C z rfpt' f '
OWNER
LOT
BLOCK
SUBDIVIS ON
,�} /'
,fir •
i
'IS !�
�
t°'
I
/
G'f/�
#,r!
'J(xir'f.''t
i '
dd"liami cShores
F L H I D A
PLUMBING PERMIT
f
to install the following described plumbing, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
/ building g a c2.1
For a ;/ story
Fixtures
Fixtures
Sewer
tic Tank
$
$
Total $
Village Plumbing Inspector
Received Payment by
N9 1123
with the laws, statutes and regu-
Florida, governing plumbing and
/ C z rfpt' f '
OWNER
LOT
BLOCK
SUBDIVISIOpl
• /
Issued to
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbic$ and
drainage work done in Miami Shores Village, Florida. r
For a / story tf building at 2
Fixtures
Fixtures
Sewer
$
•ic Tank $ f
Total $
aiami cSlzores llage
F L O H I D A
PLUMBING PERMIT
:..r
Village Plumbing Inspector_
Received Payment by
N9 1243
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Li PERMIT N9 14625
L] Work to be performed under this Permit
Contractor
or Builder
Legal Lot II Bi.
Descri ption
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
DATE
Contractor's
License No.
t. of
Permit $
BY AUTHORITY
195
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
here for 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
tirne 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.
OWNER
LOT
BLOCK
SUBDIVISION
Date ( *
ai ore s9llage
L ami A cJh I D A
PLUMBING PERMIT N9 1123
Issued to
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a_ story 1 building at
Fixtures - -- -
Fixtures
Sewer
Septic Tank ______
•
$
Total $
Village Plumbing Inspector
Received Payment by -
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
1r
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 4779
Subdi-
vision
DATE
Contractor'
License No
Work to be performed under this Permit t ` 1
1944
Address of t ,• Value of Amt. of r� `
Building __. ,s: y � Project Permit `'
This p nit is granted to the contrictk or builder named above to construct the building or to install the equipment or device escribed in the appli-
cation 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 respon-
sibility for work done by his agents, servants or employees. ,`
Signed: ....., By
INSPECTOR
In consideration of the issuance to me of this pernnt I agree to perform the work covered hereunder in • ompliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Dliami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
PERMIT N2 4779
Work to be performed under
A A
Architect
Contractor`
or Builder y .0 '- .Y.�. •
Legal Lok!, Bl.
Description
Address of
Building
CONTRACTOR `OIL BUILDER
MIAMI SHORES VILLAGE, FLORIDA
J
DATE 194
this Permit
Subdi-
vision
Value of
Project
BY
Contractor'
License No
•
Amt. of
Permit
AUTHORITY
This p it is granted to the contrite +r or builder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 tl- ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. ,. ,..a l 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.
--
Date_ _ --- --- --
Permit No.. - -.- -
>,�- made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
Appli a, in compliance and conformity with the Shores
and all ruul s and regulations o ftheBuilding Division
and a. n
buildi MIAMI SHORES VILLAGE
struct - •" .a' ;fixations must he kept at
of Mi
Owne PLUMBING INSPECTION DEPARTMENT
Regist APPLICATION FOR PLUMBING PERMIT
Emplo.
mit No.
Locatio
lication is hereby made for the a Date _
Street an pproval of the detailed statement of the plans and specifications herewith submitted For the building or other
ure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
State wo'1 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Di\"i Sion
tmi Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at
New Bui ig during progress of work.
i 's Name and Address.. _
No.
__ Street...
c NTCR. cred Architect and /or Engineer____
LIST
'laying Plumber's N .___
CHE _ _____ No
= acation and Legal Description Lot Street.___. _
Block Subdivision
—Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) Street ___ _
_
New Building li
Remodeng
Addition
CONTR.
LIST
CHECK
CLOSETS
BATH
TUBS
Feet of Drain Tile
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank -_------------ --- - - - - -- - - -- - - - -- -- __ Type of Tank
Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
Size of Soakage Pit
Amount of Permit $
(Signed)
Plumbing Inspector.
The undersigned applicant for this building
under the Florida Workmen's Compensation A, being Section 5966, Compiled General Laws ds of Flo ida Pern ane t en t, andeh s labor
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 Shores Village.
(Signed)
Repairs__ No. of Stories
DRINKING
FOUNT •
Capacity Gals. _.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
Master Plumber.
to me well known, and who, being by me first duly swam, 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
therein by him stated are true.
Notary Public, State of Florida
materials and /or workmanship.
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
TOTAL
FIXTURES
LIST - --
CHECK 1
-nit No.
Size Septic Tank
Feet of Drain Tile _
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
tication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
ure herein described. This application is inade in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
'1 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
_mi Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at
.g during progress of work.
s Name and Address_ - .___ No. ! Street...
ered Architect and /or Engineer_ _
:toying Plumber's Name_ __ _, No. Street
.cation and Legal Description Lot Block Subdivision
.,treet and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors)
New Building . Remodeling Addition Repairs
of Tank Capacity Gals. -
_____ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
(Signed)
Date
No. of Stories _
(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
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 Shores Village.
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
therein by him stated are true.
Master Plumber.
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
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.
BATH S
SHOWERS L
LAVA- S
SINKS S
SLOP L
LAUNDRY U
URINALS C
CATCH F
FLOOR D
DRINKING I
I T
TOTAL
CONTR.
LIST
CHECK
SEPTIC SEWER D
DRAIN S
SOAKAGE G
GREASE S
SOLAR D
DEEP S
SPRKLR. S
SW IM'G
CONTR.
-nit No.
Size Septic Tank
Feet of Drain Tile _
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
tication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
ure herein described. This application is inade in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
'1 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
_mi Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at
.g during progress of work.
s Name and Address_ - .___ No. ! Street...
ered Architect and /or Engineer_ _
:toying Plumber's Name_ __ _, No. Street
.cation and Legal Description Lot Block Subdivision
.,treet and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors)
New Building . Remodeling Addition Repairs
of Tank Capacity Gals. -
_____ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
(Signed)
Date
No. of Stories _
(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
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 Shores Village.
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
therein by him stated are true.
Master Plumber.
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
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.
New Building -
Amount of Permit $
Ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _ -- - __ -_ _ Date. -- __ - - -
-
Application is hereby made for the appro'<al 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 he kept at
building during progress of work.
No
Owner's Name and Address -
Registered Architect and /or Engineer
Employing Plumber's Name . _ . No. _ Street
Location and Legal Description Lot - Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition _ Repairs.
Size Septic Tank_ - - -- Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Dram Field firm Well• _
Nature of Water Supply: City —Nell . Size of Soakage Pit
( Signed)
( Signed)
__ - Street._
Capacity Gals.
No. of Stories
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 he
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 a ■rf•
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as arc
licensed by Miami Shores Village.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 saute, and that all facts
therein by him stated are true.
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.
BATH
CLOSETS TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
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
CONTR.
LIST
—
—
CHECK
New Building -
Amount of Permit $
Ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _ -- - __ -_ _ Date. -- __ - - -
-
Application is hereby made for the appro'<al 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 he kept at
building during progress of work.
No
Owner's Name and Address -
Registered Architect and /or Engineer
Employing Plumber's Name . _ . No. _ Street
Location and Legal Description Lot - Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition _ Repairs.
Size Septic Tank_ - - -- Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Dram Field firm Well• _
Nature of Water Supply: City —Nell . Size of Soakage Pit
( Signed)
( Signed)
__ - Street._
Capacity Gals.
No. of Stories
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 he
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 a ■rf•
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as arc
licensed by Miami Shores Village.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 saute, and that all facts
therein by him stated are true.
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.
Permit No
Owners Name and Address
Registered Architect and /or Engineer
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 sad 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, whethar herein apesified or not. A copy of a >, plans and specifications must be kept at
building during progress of work. //�
\` U 7 E - A'0 No ______ ° Street._! ° F 9 2' s5
Employing Flttuabo� Naar L + i d .NN e ' /
V : 'Pr , - 0766 Gues
Location and Legal Description Lot.. BIB Subdivision..___ --_
Street and Numbs: where work is to be performed —No. � Street �C.1C . _. 9_7 _ ___
State work to be performed and purpose of building (By Fkran)__._.) am( _ ` ri ._34 -d d ° gA9i' ..0. .0.''...._ .
New Building__-_-. —_ - - Remodeling--- _-- .-._____ Addition...____... -_ Repairs t/ No. of Stories.
Size Septic Tank__ -Type of Tank_
Feet of Drain Tile _Dist Feet of Tan or Drain Fick' from
Nature of of Water Supply: City —Well. Size of Soakage Pit
(Si
(Signed)-? ^.4 -,Q) 4s :-- --
Notary Public. State of Florida
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 5 , Compiled General Laws of Florida Permanent Supplement, and bar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort to be
performed under this permit; and will post or cause to be posted for inspection on the site of the w• 4 public notice or notices as
required by the Act. The undersigned agrees to employ only such sub- contractors, . k to . • ormed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,'
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first defy swam, upon oath deposes =,t..s says that he is the
of the above described construction, that he btu carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be tnada when 81114* cote i8 man by improper notice for inspection, ®r faulty
materials and /or walomaaship.
CLOSETS
BATH
Tuns
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDR
Tuv•
URINALS
CATCH
DAStN
FLOOR
DRAIN
DRINKING
FOUNT' N•
TOTAL
PIIITUR[S
CONTR.
LIST
CHECK
-�
SEPTIC
TANK
S[W[R
CONN.
DRAIN
FIELD
SOAKAGE
PIT
CREAM
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•O
POOL
CONTII.
LIST
r-
CHECK
Permit No
Owners Name and Address
Registered Architect and /or Engineer
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 sad 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, whethar herein apesified or not. A copy of a >, plans and specifications must be kept at
building during progress of work. //�
\` U 7 E - A'0 No ______ ° Street._! ° F 9 2' s5
Employing Flttuabo� Naar L + i d .NN e ' /
V : 'Pr , - 0766 Gues
Location and Legal Description Lot.. BIB Subdivision..___ --_
Street and Numbs: where work is to be performed —No. � Street �C.1C . _. 9_7 _ ___
State work to be performed and purpose of building (By Fkran)__._.) am( _ ` ri ._34 -d d ° gA9i' ..0. .0.''...._ .
New Building__-_-. —_ - - Remodeling--- _-- .-._____ Addition...____... -_ Repairs t/ No. of Stories.
Size Septic Tank__ -Type of Tank_
Feet of Drain Tile _Dist Feet of Tan or Drain Fick' from
Nature of of Water Supply: City —Well. Size of Soakage Pit
(Si
(Signed)-? ^.4 -,Q) 4s :-- --
Notary Public. State of Florida
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 5 , Compiled General Laws of Florida Permanent Supplement, and bar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort to be
performed under this permit; and will post or cause to be posted for inspection on the site of the w• 4 public notice or notices as
required by the Act. The undersigned agrees to employ only such sub- contractors, . k to . • ormed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,'
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first defy swam, upon oath deposes =,t..s says that he is the
of the above described construction, that he btu carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be tnada when 81114* cote i8 man by improper notice for inspection, ®r faulty
materials and /or walomaaship.