PLUMBING PERMITBUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Owner's Name and Address .,!l tetA<,
Registered Architect and /or Engineer
Name and address of licensed contractor
MIAMI SHORES VILLAGE
• .[,..... _.•t.•]:,t..,,..,....n....,,.
0 c4 Get_ - ... �` ` _
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of buildin (by floors)
..... - 24,t.
New Bui!ding Remodeling
To be constructed of 111 of
Estimated Total cost of improvements $
Zone cubage required
Date.. y � =
No. /0 2...__.._.. Street_Z •• 4.:... Z SI...
.Plan Cubage
and for no other purpose.
Addition Repairs No. of Stories
foundation Roof Covering
ti mss.
...... Amount of Permit .5
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
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 complied 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village. •
Remarks (Signed).. .._......1L�_'1L
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No.._..1 -2 5 Z 7 Date 1 l //
— Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Date.
Building Inspector
Notary Public, State of Florida
My Commission Expires
to me well known,
PLAFKININC BOARD DATE
Chairinan Member
Member _ Member
Member ...... Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Permit No..... ... Date J / 7 r
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...
Owners Name and Addres.12
Registered Architect and /or
Employing Plumber's N
Location and Legal bescriptio . t_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed —No J a 0
State work to be performed and purpose of building (By Floors)
New Building-- -_ _ _ _ _ Remodeling Additi .__..... Repairs
No. /t ? v ,) E street.
7
u
Street.. ...._.,
No. of Stories.
Size Septic Tani Type of Tank_ y U
_..___... ty
Feet of Drain Tile. ----- _.._____ ___YDist. Feet of Tank or Drain Field from Well..._-_._-- ` •
Nature of Water Supply: City—Well Size of Soakage Pit
Amount of Permit $
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 5968, Compiled General Laws of Florida Permanent Supplement, and hug 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.
STATE OF FLORIDA, }
COUNTY OF DADE.
(Signed)_
(Sign
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 dep oses 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
mater OTE: Arrw inspection pee of X1.00 will be made when such re- inspection is made•neoessary by Improper nodes for inspection, or faulty
CLOSETS
BATH
TU SS
S HOWERS
uYA•
TORI
SINKS
SLOP
SINKS
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
FIXTURES
CONTR.
LIST
CHICK
�'�
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
..
CONTR.
L
LIST
CHECK
r --
_
Permit No..... ... Date J / 7 r
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...
Owners Name and Addres.12
Registered Architect and /or
Employing Plumber's N
Location and Legal bescriptio . t_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed —No J a 0
State work to be performed and purpose of building (By Floors)
New Building-- -_ _ _ _ _ Remodeling Additi .__..... Repairs
No. /t ? v ,) E street.
7
u
Street.. ...._.,
No. of Stories.
Size Septic Tani Type of Tank_ y U
_..___... ty
Feet of Drain Tile. ----- _.._____ ___YDist. Feet of Tank or Drain Field from Well..._-_._-- ` •
Nature of Water Supply: City—Well Size of Soakage Pit
Amount of Permit $
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 5968, Compiled General Laws of Florida Permanent Supplement, and hug 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.
STATE OF FLORIDA, }
COUNTY OF DADE.
(Signed)_
(Sign
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 dep oses 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
mater OTE: Arrw inspection pee of X1.00 will be made when such re- inspection is made•neoessary by Improper nodes for inspection, or faulty
Permit No
3 3 Date 3/7/61
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 Dean Claus sen 1005 NE _ Street- 98th
Brooks
_ Sprinkler Co.
Registered Architect and /or Engineer---- _
Employing Plumber's Name
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' e,;,MIT
No..88° N4V----- - - - - -- Street._ 54th
Location and Legal Description Lot_.._ _._..___._._._._____..___.____ ________ Block__ ___.__.._________ -_ -- Subdivision
Street and Number where work is to be performed -No 1020 NE 99th
State work to be performed and purpose of building (By Floors ) __
New Building _ Remodeling---- _.------------- ____ -- Addition
Amount of Permit $ 8 .00
- -- - - - My Commission Expires
Street
Repairs No. of Stories
Size Septic Tank _..___ Type of Tank
Feet of Drain ................. _________Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well.__._._ _ _ _ _____Size of Soakage Pit
Capacity Gals
(Signed)_
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce s his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo . a 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 erformed under this permit, as are
licensed by Miami Shores Village.
(Signed)._
ti
Plumber.
STATE OF FLORIDA, I
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 'ay him stated are true.
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
TUBE
SHOWERS
LAVA-
TORIES
SI NKS
SLOP
SINKS
LAUNDRY
Tulle
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'S
POOL
co. NTR
LIST
2"
R
—
- --
_.
CHECK
Permit No
3 3 Date 3/7/61
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 Dean Claus sen 1005 NE _ Street- 98th
Brooks
_ Sprinkler Co.
Registered Architect and /or Engineer---- _
Employing Plumber's Name
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' e,;,MIT
No..88° N4V----- - - - - -- Street._ 54th
Location and Legal Description Lot_.._ _._..___._._._._____..___.____ ________ Block__ ___.__.._________ -_ -- Subdivision
Street and Number where work is to be performed -No 1020 NE 99th
State work to be performed and purpose of building (By Floors ) __
New Building _ Remodeling---- _.------------- ____ -- Addition
Amount of Permit $ 8 .00
- -- - - - My Commission Expires
Street
Repairs No. of Stories
Size Septic Tank _..___ Type of Tank
Feet of Drain ................. _________Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well.__._._ _ _ _ _____Size of Soakage Pit
Capacity Gals
(Signed)_
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce s his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo . a 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 erformed under this permit, as are
licensed by Miami Shores Village.
(Signed)._
ti
Plumber.
STATE OF FLORIDA, I
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 'ay him stated are true.
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.
l
Perc..ii No.__.___ ____
_____.___
New uilding_. _.._.._____ ________ Remodeling —__ __.__.._ Addition.
Type of Tank
Feet of Drain Tile.__-___ _______________________________ —Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup c Well ____._Size of Soakage Pit
Size Septic Tank
Amount of Permit $-_
STATE OF FLORIDA, �.
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date .1/ -
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 C���� No.
Registexed Architect and/or En ineer
Employing Plumber's Name
Location and Legal Descripti .... . _ -_ _ - _. -_._ --. Block Subdivision
Street and Number where work is to be performed—No. ..2_=._:_ �
ry r .- -- - - -� -- �+ � .. Street
s
��� ..d__
State work to be performed and purpose of building (By Floors)__- ... __._________ - - -_ -_ /
Repairs No. of Stories. _ l
Street.
Capacity Gals
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and a • f e is 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.
Master Plumber.
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 workmanship.
HASH
CLOJ>:'P'3 I TUBS
S HOWHRS
TORIES
SIN"
SLOP
SINKS
LAUNDRY
TUBE
NALS
CATCH
BASIN
FLOOR
DRAIN
DRINKI NO
FOUNT' NS
TOTAL
FIXTURES
C
LIST
1 _
�/
/ •
' .
CHECK
'
--
--
.PTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
8etleft
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
tdeld
w
f�
CONTR.
LIST
CHECK
CHECK
/
/
/ —
--
l
Perc..ii No.__.___ ____
_____.___
New uilding_. _.._.._____ ________ Remodeling —__ __.__.._ Addition.
Type of Tank
Feet of Drain Tile.__-___ _______________________________ —Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup c Well ____._Size of Soakage Pit
Size Septic Tank
Amount of Permit $-_
STATE OF FLORIDA, �.
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date .1/ -
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 C���� No.
Registexed Architect and/or En ineer
Employing Plumber's Name
Location and Legal Descripti .... . _ -_ _ - _. -_._ --. Block Subdivision
Street and Number where work is to be performed—No. ..2_=._:_ �
ry r .- -- - - -� -- �+ � .. Street
s
��� ..d__
State work to be performed and purpose of building (By Floors)__- ... __._________ - - -_ -_ /
Repairs No. of Stories. _ l
Street.
Capacity Gals
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and a • f e is 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.
Master Plumber.
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 workmanship.
f :.—r No / . — Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subfnitted 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 ............ _ - ____--+EGA
Registered Architect and /or Engin r_
Employing Plumber's Name
Location and Legal Description Lot / Bl
Street and Number where work is to be performed —No / i
State work to be performed and purpose of building (By Floors)--_.______-_______
New Building .______ Remodeling_ __ ___ __ Addition_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Repairs
— Street
Street — — — -
Subdivision
Street
No. of Stories.
Size Septic Tank
Feet of Drain Tile e - --
Nature of Water Supply: City —Well
Amount of Permit $
,Type of Tank_ — Capacity Gals .....
. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pen
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted' for inspection on the site of the work
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
ons as an employer of labor
Supplement, and has com-
yed by him in the work to be
public notice or notices as are
ormed under this permit, as are
(Signed)_._ _ -/ f b-
- Master Plumber.
STATE OF FLORIDA, 1 85.
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.
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 /a worlomanship.
CLOUTS
BATH
Tuse
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tues
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
-
-
f :.—r No / . — Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subfnitted 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 ............ _ - ____--+EGA
Registered Architect and /or Engin r_
Employing Plumber's Name
Location and Legal Description Lot / Bl
Street and Number where work is to be performed —No / i
State work to be performed and purpose of building (By Floors)--_.______-_______
New Building .______ Remodeling_ __ ___ __ Addition_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Repairs
— Street
Street — — — -
Subdivision
Street
No. of Stories.
Size Septic Tank
Feet of Drain Tile e - --
Nature of Water Supply: City —Well
Amount of Permit $
,Type of Tank_ — Capacity Gals .....
. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pen
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted' for inspection on the site of the work
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
ons as an employer of labor
Supplement, and has com-
yed by him in the work to be
public notice or notices as are
ormed under this permit, as are
(Signed)_._ _ -/ f b-
- Master Plumber.
STATE OF FLORIDA, 1 85.
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.
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 /a worlomanship.