375 NE 99 St (8)Permit No
i640 7
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 Address
Registered Architect and /or En
tt�� M'AMid►+
a �o�-P4 �; �1 _$''' s3ND G1 R! A
LoLocation an Legd Descri ption Lot d" w 0
Street and Number where work is to be performed —No i, 7 S
New Building.
Amount of Permit $ 3
My Coaunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
PLE 704 ' N o 37 S Str ee t .._ 9. ! S
ANg
S.Z1L
014 SoPFr viC
Repairs f No. of Stories ................
3 Block `" D SubdivWon. _
State work to be performed and purpose of building (By Floors) 114lt 1L`LrfaCrArell__ 205QFr OF 1
Remodeling Addition.
Size Septic Tank_.- Type of Tank. —
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
...--__--. —
Nature of Water Supply: ize of Soakage Pit.
(Signed)
Plumbing Inspector.
The undersigned applicant for thls 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 ban rnm-
pued with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e .. toyed by him in the work oo br
ublic notice or notices as err
er this permit, as are
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
licensed by Miami Shores Village.
(
S
Street[ v E_ L 9 s7 -.
Notary Public, State of Florida
STATE OF FLORIDA, 1 ss.
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 be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be loads wham iamb re.hrpeottoe la made. as mmery by improper notice for Inspection, or faulty
materials and /or workmanship.
CLOarra
BATH
Tina
fHOW[Ra
LAVA•
TONICS
SINKS
St OP
SINKS
LAUNORT
Tuaa
CATCH
•ASIN
FLOOR
DRAIN
DRINKING
roUNT'NS
TOTAL
PIXTVRES
CONTK.
LIST
CHECK
SEPTIC
TANK
a[W[R
CONN.
DRAIN
PILO [
80AKAO[
PIT
G
TRAP
SOLAR
H[AT[R
Daw.
WELL
S
S
SWIN'O
POOL
CoNTR.
LIFT
CHECK
Permit No
i640 7
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of. Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address
Registered Architect and /or En
tt�� M'AMid►+
a �o�-P4 �; �1 _$''' s3ND G1 R! A
LoLocation an Legd Descri ption Lot d" w 0
Street and Number where work is to be performed —No i, 7 S
New Building.
Amount of Permit $ 3
My Coaunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
PLE 704 ' N o 37 S Str ee t .._ 9. ! S
ANg
S.Z1L
014 SoPFr viC
Repairs f No. of Stories ................
3 Block `" D SubdivWon. _
State work to be performed and purpose of building (By Floors) 114lt 1L`LrfaCrArell__ 205QFr OF 1
Remodeling Addition.
Size Septic Tank_.- Type of Tank. —
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
...--__--. —
Nature of Water Supply: ize of Soakage Pit.
(Signed)
Plumbing Inspector.
The undersigned applicant for thls 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 ban rnm-
pued with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e .. toyed by him in the work oo br
ublic notice or notices as err
er this permit, as are
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
licensed by Miami Shores Village.
(
S
Street[ v E_ L 9 s7 -.
Notary Public, State of Florida
STATE OF FLORIDA, 1 ss.
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 be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be loads wham iamb re.hrpeottoe la made. as mmery by improper notice for Inspection, or faulty
materials and /or workmanship.
Tad-. airfria
e,tdd
�Ii.,,_„2
41„z-2/6,5 / /S/
S/ 1.-.
718 ”1-4
375 we %,S/.
4(,,e1 11c2 PZ /4,S=
2 k / e6 —
/,-7,,,s,
Size Septic Tank_ _________
---- ----- - - - - - --
Feet of Drain Tile
Nature of Water Supply: City - Well
Amount of Permit $_
STATE OF FLORIDA, !
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
•L:"1- R C J l i /,‘
Permit No _ _____._ _� Date____ 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
P �/
urm r e � n '/
Owner's Name and Address ________i � ' ��� r
No._ — _ -___ Street
Registered Architect and /or Engineer ----- -- -_- -___----- - - - - -- - �.
Employing Plumber's Name_ ?
111;11'11__ C' trt'tC_SPt e �'ft_ - -_ No. -___ ? CI V �=) "
- - -- � _ _ • Street-A kS,r
Location and Legal Description Lot --_ -. _------ -_.___ _ _ —_. Block_ _ Subdivision --___- -- - - - -- _
Street and Number where work is to be performed -No 7j
State work to be performed and purpose of building (By Floors)__.-______Jl..1,-1-1i
7 ,.. Street_ A / c 1 cl - - A New Building ___ Remodeling___ - -_-_ Addition. -._ ._ Repairs No. of Stories_
Type of Tank___ Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perman
plied with the provisions thereof, and will require similar compliance from all contractors or sub -co
performed under this permit; and will post or cause to be posted' for inspection on the site of
required by the Act. The undersigned agrees to employ only such sub- contractors
licensed by Miami Shores Village.
ons as an employer of labor
Supplement, and has corn -
yed by him in the work to be
uc ' ' public notice or notices as are
w� to be .. erformed under this permit, as are
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.
Notary Public, State of Florida
Master Plumber.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuea
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TORES
Cowie.
LIST
CHECK
—
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
~`
Size Septic Tank_ _________
---- ----- - - - - - --
Feet of Drain Tile
Nature of Water Supply: City - Well
Amount of Permit $_
STATE OF FLORIDA, !
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
•L:"1- R C J l i /,‘
Permit No _ _____._ _� Date____ 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
P �/
urm r e � n '/
Owner's Name and Address ________i � ' ��� r
No._ — _ -___ Street
Registered Architect and /or Engineer ----- -- -_- -___----- - - - - -- - �.
Employing Plumber's Name_ ?
111;11'11__ C' trt'tC_SPt e �'ft_ - -_ No. -___ ? CI V �=) "
- - -- � _ _ • Street-A kS,r
Location and Legal Description Lot --_ -. _------ -_.___ _ _ —_. Block_ _ Subdivision --___- -- - - - -- _
Street and Number where work is to be performed -No 7j
State work to be performed and purpose of building (By Floors)__.-______Jl..1,-1-1i
7 ,.. Street_ A / c 1 cl - - A New Building ___ Remodeling___ - -_-_ Addition. -._ ._ Repairs No. of Stories_
Type of Tank___ Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perman
plied with the provisions thereof, and will require similar compliance from all contractors or sub -co
performed under this permit; and will post or cause to be posted' for inspection on the site of
required by the Act. The undersigned agrees to employ only such sub- contractors
licensed by Miami Shores Village.
ons as an employer of labor
Supplement, and has corn -
yed by him in the work to be
uc ' ' public notice or notices as are
w� to be .. erformed under this permit, as are
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.
Notary Public, State of Florida
Master Plumber.
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.
•
plans, dmvssags, notentente or spoci'ficatients *t ay have been submitted to and approved by the proper
at any time if the work is not done in compliaace with such ordicances or if the pions ate changed withoot
permit ie grafted is fife naderstandiSig that the contractor or builder named above mottles the responsibility
vegolotions pertaining to the work covered hereby whether shown OR the plans or drawings 9
sibility for work done by his agents, servants er employees.
3-fr
Thie permit is granted to the contractor or builder centstrect the Wild*" or to install the assignment er device described in the applica-
tion hornier it *Int onnplionne with nil ordinanues pastainiog then. and maids the undemeandres that the work. will be performed ia compliance with any
authorities. This Pons* mew be revoked
• . A further condition upon which this
knowledge et the - ,oes and
d that he espon-
a _At t4
IMP
to
f or a tho
cep t1n
Wok 11e perfome
6221
Value of
II Amount s l us ?
penult
AUTilOR
Wits of
. :.
Bttikritg ,r�. 1 ter' $ ,t ' _. .
This ie contractor or builder named above to constant `ttbe boldimg,ox to install the anipatent deeiee deset'ihod in tin affirm*.
or in ets with all ordinances pertaining thereto and with the ondetstan►dingN.that the work will be performed in compliance with any per,
been submitted to and by the paper , astitorities. This Permit may be embed at
..x . is _ - tech ordinances or ii the plats hat ; w . A further condition which skis
;peetted ittfrettaileetestelher that bailee dies 1111110011 above of
lie wee eaves .: ; whetbee eheiva ee the plume or tleawieltpter s, fitteeelhaehos im
agents. sera
R OR BORDER
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildin4 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__
Registered Architect and /or Engine r — __ —___ -__ --
Employing Plumber's Name__ y l ._ -- ' >-�' "�'''' - No.. .-�
�� �.- ----- - - - --- � - � Street.. _.ifs � �'
Location and Legal ..... Block
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_
New Building
Size Septic Tank Type of Tank
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well.
:___Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $ - ii/A19—
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ^ ;b4.MIT
Remodeling_ Addition._____._ Repairs No. of Stories.
( Signed) _
7 c
My Commission Expires
(Signed).
Date
Subdivision
Capacity Gals
Notary Public, State of Florida
-J
Street
Plum • g Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h' ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ' rmanent 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 die 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.
STATE OF FLORIDA, 1 u.
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•neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
DAA IN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
It
£ .- '
-
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildin4 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__
Registered Architect and /or Engine r — __ —___ -__ --
Employing Plumber's Name__ y l ._ -- ' >-�' "�'''' - No.. .-�
�� �.- ----- - - - --- � - � Street.. _.ifs � �'
Location and Legal ..... Block
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_
New Building
Size Septic Tank Type of Tank
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well.
:___Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $ - ii/A19—
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ^ ;b4.MIT
Remodeling_ Addition._____._ Repairs No. of Stories.
( Signed) _
7 c
My Commission Expires
(Signed).
Date
Subdivision
Capacity Gals
Notary Public, State of Florida
-J
Street
Plum • g Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h' ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ' rmanent 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 die 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.
STATE OF FLORIDA, 1 u.
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•neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
'MIAM ORES VILLAGE, FLA.
to
JOB
ADDRESS
INSPECTION
TIME READY
N? 5978
REMARKS.
iiKECTOR DATE
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the ilding or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores illage, 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 /7` 2 t No.? 7_6' _AE Street_.
Registered Architect and /or Engineer_.
Employing P}lloifr's Name___PnOW J 46. - c5L P T
Location and Legal Description Lot_ ____.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) ___.______.._____.___._.__.____
New Building ____ ___ Remodeling__ __ ________ Addition________ Repairs No. of Stories
Amount of Permit $
STATE OF FLORIDA, ( u.
COUNTY OF DADE.
---- _---- ___ -___ My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING " "TIT
,72 e 0 No._ j C3 1Yl Street. 21 _ 4._.
Block_
Size Septic Tank 1L___i Q _ Type of Tank-_
(Signed
Date
-- ____ -- Subdivision
Street
Capacity Gals
Feet of Drain Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .______ _____Size of Soakage Pit
(Signed)
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 Worlanen'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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work performed under this permit, as are
licensed by Miami Shores Village.
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.
Notary Public, State of Florida
aster Plumber.
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
Tues
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuff
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NB
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the ilding or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores illage, 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 /7` 2 t No.? 7_6' _AE Street_.
Registered Architect and /or Engineer_.
Employing P}lloifr's Name___PnOW J 46. - c5L P T
Location and Legal Description Lot_ ____.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) ___.______.._____.___._.__.____
New Building ____ ___ Remodeling__ __ ________ Addition________ Repairs No. of Stories
Amount of Permit $
STATE OF FLORIDA, ( u.
COUNTY OF DADE.
---- _---- ___ -___ My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING " "TIT
,72 e 0 No._ j C3 1Yl Street. 21 _ 4._.
Block_
Size Septic Tank 1L___i Q _ Type of Tank-_
(Signed
Date
-- ____ -- Subdivision
Street
Capacity Gals
Feet of Drain Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .______ _____Size of Soakage Pit
(Signed)
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 Worlanen'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
required by the Act. The undersigned agrees to employ only such sub- contractors, on work performed under this permit, as are
licensed by Miami Shores Village.
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.
Notary Public, State of Florida
aster Plumber.
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.