865 NE 97 St (6)- -^
GLOM=
ATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
S NKS
L TUBS
kitty
NH
� .
G
FO NT N6
t 14
wm
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
a
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date-_
- z 8 -
Application is Hereby mace 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__PA L
iL
No.
Registered Architect and /or Engineer_ —
Employing Plumber's Name d.-d-C_CO..g1 1e3.—__ 63 Y 0 - No._._ (1 eti .._ Stree 41�� Pe
Location and Legal Description Lot.--_...__- ... __I4 _ _ .___.__ Block 7 -g Subdivision ' ` a
Street and Number where work is t� be performed —No r" cr A/ e 9 Y S treet_
State work to be performed and purpose of building (By Floors) __
New Building ___ Remodeling- _---- - - - -__ _ —._ Addition
Street.
Repairs No. of Stories
D
Size Septic Tank_
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
(Signed)_.-- LIM
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 5986, 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
require d by the Act. The undersigned agrees to employ only such sub - contractors, on wor be performed der this ,ermit, are
Homed by Miami Shores Village.
Amount of Permit $ 2 t.
Type of Tank —___ Capacity Gals
Size of Soakage Pit
( Signed
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 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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made . necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Master ' lumber.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date — 7 Job Address e q65 . • 97 i r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant LI / L Y' l q 7
Owner's Address 5 , 6,5-- A,/ • 77 sT
Contractin Co. /9/ ///V / - � � (1 41 k a) "C--
Qualifier — T?*rl. � 3 / _
State # O ) Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL
PLUMBIN
ECHANICAL ROOFING PAVING FENCE SIGN
L 1 Art.
!mac- ' W
WORK DESCRIPTION
Square Ft. Estimated Cost (val
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR LMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the ab named contractor to do the work stated.
Signature of owner and/or Condo Q /. ent
FEES: PERMIT
ate
Notary as to Owner and/or Condo President Date
My Commission Expires:
OFFICIAL NOTARY SEAL
ODALIS THOMAS
ARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC771993
MY COMMISSION EXP. AUG. 31;2002
•
RADON
Address
(Zotoci,,
C.C.F. 1 ' .3 NOTARY
Master Permit # 9 V,2 s6
Phone 3&S 7,5 7-" (5'WeP
SS# c 3 7 / "D 0°7
Competency # Ins. Co.
Address
Address
r--
ignature of Contractor or Owner- Builde'
Notary as to Contractor or Owner- Builder
My Commission Expires:
OFFICIAL NOTARY SEAL
ODALIS THOMAS
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC771993
MY COMMISSION EXP. AUG. 31,2002
BOND
z — / 7 17
Date
Ct,e. cL — / 7 -� g
Date
TOTAL DUE 6
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
�.---
CLOSETS
TATS
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINAL
CATCH
B
BASIN IN
FLOOR
DRAIN
DRINK! NO
FO
FOUNT' N6
TOTAL
FIXTURE$
CONTR.
LIAT
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
Pestnit No.
Date ill !_L
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. . a.....ceed
69
Owner's Name and Address
Registered Architect and /or En ineer__
Employing Plumber's Name._
Location and Legal Description Lot_- __.._-__
Sir.e Septic Tank.. - -Z -- -_ -• --
Feet of Drain Tile :5
Nature of Water Supply: City —Well.
Amount of Permit $ t
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
Street and Number where work is to be performed —No -Z. Street
State work to be performe8 and purpose of building (By Floors) __ ___
New Building — .._.___ Remodeling ._ __.___ Addition Repairs No. of Stories.
of Tank
eet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)_
Capacity Gals
Street
Street__
Subdivision
l
(
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 bus 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.
(Signed) - - -/ T/6,
— Master Plumber.
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 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.
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 worlananship.