1279 NE 98 St (5)Owner's Name and Address ____________
_:- _____� tGy
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By _._._ _.fFsr.a..__T6e.�
Size Septic Tank _____ Type of Tank -_
Feet of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well..____ _____Size of Soakage Pit
o-�
- - - - - -- - - -- -- - -� (Signed)
Date.
f y.l Street_ _.
Application is hereby , :acie for the approval of the detailed statement of the plans and specifications herewith submitted for t'buildin 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.
No._.___ / Stree
Capacity Gals
My Commission Expires Notary Public, State of Florida
Registered Architect and /or Enginee ____t,_ —_ '
Employing Plumber's Namu � J �G l " -1 /C No.
Location and Legal Description L o t _ _ JL _ L l _ / 7 ___Block_ Subdivision I.
Street and Number where work is to be performed— No.__/2 f --- ..... —___ Street 1 ..,r ' C' 9:1 .0 ,
New Building ___ Remodeling __.__ ___.__ Addition `' __ Repairs No. of Stories.
Plumbing Inspecto
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o. rations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per :. ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors ployed 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). ____
Master Plumber.
STATE OF FLORIDA, I as.
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 /or workmanship.
CLOSETS
BATH
TUBS
OWERS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' Ns
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN.
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IN'G
POOL
CONTR.
LIST
CHECK
�TSn
Owner's Name and Address ____________
_:- _____� tGy
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By _._._ _.fFsr.a..__T6e.�
Size Septic Tank _____ Type of Tank -_
Feet of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well..____ _____Size of Soakage Pit
o-�
- - - - - -- - - -- -- - -� (Signed)
Date.
f y.l Street_ _.
Application is hereby , :acie for the approval of the detailed statement of the plans and specifications herewith submitted for t'buildin 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.
No._.___ / Stree
Capacity Gals
My Commission Expires Notary Public, State of Florida
Registered Architect and /or Enginee ____t,_ —_ '
Employing Plumber's Namu � J �G l " -1 /C No.
Location and Legal Description L o t _ _ JL _ L l _ / 7 ___Block_ Subdivision I.
Street and Number where work is to be performed— No.__/2 f --- ..... —___ Street 1 ..,r ' C' 9:1 .0 ,
New Building ___ Remodeling __.__ ___.__ Addition `' __ Repairs No. of Stories.
Plumbing Inspecto
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o. rations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per :. ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors ployed 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). ____
Master Plumber.
STATE OF FLORIDA, I as.
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 /or workmanship.
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CON1ll"XCTOR OR BtiiILDBR
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lines per
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WAN'
ATILDING 0
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IMVIBING IE
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3wner of
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architect
ontractor
r Builder
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'escription,
`ddress of
uilding 1'?
This permit is granted to the co
ere-for in strict compliance with all o
rawings, statements or specifications
ine if the work is not done in complia
ranted is the understanding that the c+
ertaining to the work covered hereby
one by his agents, servants or employ
In consideration of the issuance to 'site
ertaining thereto and in strict conformity with
a accepting this permit I assume responsibility