1286 NE 98 St (10)- -+
CLOUTS
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LAVA.
TORIES
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SLOP
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URINALS
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FOUNT 'NS
TOTAL
FIXTURES
CONTR.
LIST
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SEPTIC
TANK
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FIELD
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TRAP
SOLAR
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DEEP
WELL
SPRKLR.
SYSTEM
SWIAUG
POOL
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Lint
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Permit No f ` g
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 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. 11 Q Q f
Ownei s Nana and Address •�`f a ^ /b LA-A. No. Street_. / E
4 �' . 9 g .
Registered Architect and /or Engineer
Employing Plumber's N,ime 4, l ti h P\ c...... N0. . 4 3 ,.,u. mina() 35 .. � 1.` •
Location and Legal Description Lot_ B1ock Subdivision
Street.l_a.._ . _. G • _. _ T •
State work to be performed and purpose of building (By Floors) EA - 4 - oh( j
New Building.__._ _ _.-- ••--- ......_.. Remodeling v —__ Addition.. ___ —. _._ Repairs. No. of Stories............
Street and Number where work is to be performed -No
.... _...___
Size Septic T Type of Tar
Feet of Drain Tile ___Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City -We1L _.— Size of Soakage Pit.
Amount of Permit $
( Signed )-
Plumb . spec
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o• gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, 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.
(Signed)— >L
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 fads
therein by him stated are true.
My Commission Esping Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when scab r,ispsotloa le eadraawgrary by improper notice for inspection, or faahty
materials and /or workmanship.
Owner' Name and Address._
MIAMI SHORES VILLAGE
BUILDIN<. INSPECTION DEPARTMEN -
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det..iled statemen of the plans and specifications herewith submitted for the build-
ing or o her structure her: i. described This 1-t licatic . is made in compliance and con n ty w.th the Building Ordinance of Mia ii
Shores Village, 1 tor.da, and all pro isions of tlx: Law c f the State of I•l�rid. all o d nances .,f Mi in Shores Village- and all iules and
regula` ions of the Building Dive: i of ' a.un Sho, illage .l '1 e - -o ipl.ed with, whether herein specified or not. A copy of approved
plans and specificatr,n must be ke! , at build:1.g durin, progress of tl.e work.
Registered Architect and /or Engineer _ _
Name nd address of licensed contractor
Location and legal description of lot to be built on:
Lot __ Block..
Street and Number where work is to be done.
State work to be done and purpose of building (by floors)._
Subdivision_
Date �� �G7.. 5
- •S No..__ _ Street
C.... 7
19
and for no other purpose.
New Building_ .. _ Remodeling _ Addition _ -_ . .. __ . Repairs . No. of Stories
Roof Covering .
To be constructed of
Kind of foundatiori _ .
Estimated ^ . tal cost of improvements $.. 4 30" Amount c `. Permit $...
Zone ^ubage required __. .Plan Cubage_.__ -. ____
Distance to next nearest building_ _Size of Building Lot
Maximum live load to be borne by each floor _
hereby submit all the plans and speci.i,•ations for said building All notices with reference to the building and its construction may
be sent to
The uncle signed appli ant for th 's building permit does hereby certify i'ial 1.e understands and accepts his :•bligations as an emplocer
of 1- bor under he Florida Workmen's Compensation Act bang S. ton "')6ti Co: n led Crn al Laws of Florida P r ant S-1; 1, oent,
and h s compl ed w'th he prov':ions thereof, and will require s ni iar coi.r, tan e from all contractors or sub contractor., emplo -ed Nina
in the wo k to be p ri med under th s pern it and ill post or cans: to be n'sted fo • -etioa on the site of the work ,ti -h piihlir not e
or .otiees as are requir d by the Act. The u •1. r ign -d agrees to emplo) only si:ch ibcon:r. ctors, on �� b- per - i, d der this
permit as are licensed by M am. Shores \ it ge.
Remarks_ (S'g icd )
STATE OF FT ORTDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adm_nister oaths ,.nd take acknowledgments, per.onally :‘p-
peared
to me well known,
and who, being by me first d lv , worn, upon oath depoees and says t}aat he is the
of th aboe. de i. ibed istruction t. . 1 has careially read the f egoing application, and that he did sign the sane• and 11 at tads
therein by him t iced are tr ie. `_
Permit No._ -_� _ D O Date_ J Bead, Sworn to and Subscribed before me.
Disapproved . _ ____ - -- - D to
a- State te of Florida
Notary Public SFlorida (Signed) - -- -
ding Inspector My Cnm:ni:. inn Expires. . .. _
PLANNING BOARD _DATE
Chairman .- _ -. Member - -
Member _ _ Member
Member Member
Council Approved Date. Di,a; re. . <.: Date
NOTE: A charge of $1.00 will be nude for making corrections c- -•Langes t: this application it -r ; 1protu1 1, s I u l,ta lied from
the Plane. ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is m: ncc•es.ar!• 1'., improper notice h r insp. t• .i,• or l i ty
niatenals and /or workmanship.
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Loeatioo and tAiid
Street and Number
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