PLUMBINGPermit No.
Size Septic Tank_
Feet of Drain
Nature of Wa
Amount of Permit $ -------------
NOTE: A re -ins
materials and /or w
0.0/
/ V . of
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby m de for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othel
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 Divisior
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 ofiw rk„
Owners Name and Address / -1 - 7T -- /7// - I'�re No._._.- _--- - - - - -- -- Street '
Registered Architect and /or Engineer • a� °. . __ No._ Street-.
__
Employing Plumber's Name -._ -- -_ -� - .� _Ll_• � __.
-( -- - -- -� __PP.- __ ..._...._..___ ____ e -
Location and Legal Description Lot _____..._ ..__.__. ... - __- _- _-_-__ .._____Block- - ---._ . -- _- _ - -• -- , � S Subdivision---- _5? -!4' •
Street and Number where work is to be performed —No _ _____._.._ Street -./X 5. -._ / � c
State work to be performed and purpose of building (By Floors ) -
New Building - Remodeling -_ Addition__-_- .... ....... ___ Repairs.
Type of Tank_ _ Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit_
_ ___ (Signed)
Date IA
_...
Notary Public, State of Florida
_ .... No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as all employer of lab'r
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and has :van -
plied with the provisions thereof, and will require similar compliance from all contractors or sub. contractors employed by him In the wo -k 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 p Irmed under this ,, crniit, as art
licensed by Miami Shores Village.
OS
(signed) -l._ KL) o ® :�
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 .Ippeare
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 tau
therein by him stated are true.
ection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or LW
anship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SIN
i
LAUNDRY
TUs8
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRI NKINO
FOUNT•N5
.
/'1
- --
TOTAL
URLI
Comm.
LIST 6T
/
/
/
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s
_ /
B FIIXT TU / ,'
"7!
/
/ :
CHECK
--
EWER
CONN.
DRAIN
FIELD
■SOAKAO.IE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 0
POOL
SEPTIC
TANK
CONTR.
LIST
CHECK
, n)
1
Permit No.
Size Septic Tank_
Feet of Drain
Nature of Wa
Amount of Permit $ -------------
NOTE: A re -ins
materials and /or w
0.0/
/ V . of
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby m de for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othel
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 Divisior
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 ofiw rk„
Owners Name and Address / -1 - 7T -- /7// - I'�re No._._.- _--- - - - - -- -- Street '
Registered Architect and /or Engineer • a� °. . __ No._ Street-.
__
Employing Plumber's Name -._ -- -_ -� - .� _Ll_• � __.
-( -- - -- -� __PP.- __ ..._...._..___ ____ e -
Location and Legal Description Lot _____..._ ..__.__. ... - __- _- _-_-__ .._____Block- - ---._ . -- _- _ - -• -- , � S Subdivision---- _5? -!4' •
Street and Number where work is to be performed —No _ _____._.._ Street -./X 5. -._ / � c
State work to be performed and purpose of building (By Floors ) -
New Building - Remodeling -_ Addition__-_- .... ....... ___ Repairs.
Type of Tank_ _ Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit_
_ ___ (Signed)
Date IA
_...
Notary Public, State of Florida
_ .... No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as all employer of lab'r
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and has :van -
plied with the provisions thereof, and will require similar compliance from all contractors or sub. contractors employed by him In the wo -k 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 p Irmed under this ,, crniit, as art
licensed by Miami Shores Village.
OS
(signed) -l._ KL) o ® :�
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 .Ippeare
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 tau
therein by him stated are true.
ection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or LW
anship.
cc
.1