5 NE 99 St (8)CLDt[Tt
BATH
TUB•
SHOWERS
LAVA•
TORIES
SINK•
SLOP
SINKS
LAUNDRY
TUIt
URINALI
CATCH
BASIN
FLOOR DRINK NO
DRAIN FOUN
I
TOT..L
FI[TI RES
C LITR.
LI'7
--
CHECK
-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WILL
SPRKLR.
SYSTEM
SW IM O
POOL
I
LIST
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.... -
—
CHECK
Penni, No... d.3
10.00
Amount of Permit $
STATE OF FLORIDA, }
as.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
.4pph4.l111, I, hereby mode for the approval of the detailed statement of the plans and specifications herewith subr i;• .- for the building or other
tructurc herein described. This application is made in compliance and conformity with the Building Ordinance of Mi: ! Shores Village, Florida,
a,,d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic- of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept at
iuilding during progress of work.
Mark Rabinowitz
`.)wner s Name and Address No
.egi t red Architect and /or Engineer
:mploying Plumber's Name RoSO SelptiC Tank Co. N 887 -5594
P.O.Box 341 Hialeah 33011
Location and Legal Description t_
(Signed) _
(Signed)
Date 1 -8 -82
a,.,..., Street. ****
Subdivision
Street and Number where work is to be performed -No 5 N E .9 YI. —S Rot. Street
State work to be performed and purpose of building (By Floors) __ .... _. .... __..___.__ .....
_
New Building ........... __._...__ Remodeling__- __. ... --_ Addition...__.._ Repairs
Size Septic ......... 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
Capacity ^ .als... _..
No of Stones
Plumbing Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;rloyei of hallo)
under the Florida Workinen's Compensation Act, being Section 54186, Compiled General Laws of Florida Permanent Cum lement, and has von.
h/ d with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in ' rk c• b�
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pnbh notice x no icrr ss ar
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed 'a this ,):rl tic, iu •
licensed by Miami Shores Village.
Before me, the undersigned authority, a not public, duly authorized to administer oaths and take acknowledgments, per,orr; ; a ppear%
to me well known, and who, being by me first duly sworn, u • •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
therein by him stated are true.
___ �ctary Public, State of_ _,f I
.— ►TOMXi UE t1, tj 4
.► — p ended .Ihru Troy Fein Ipsuranc• ins,
NOTE: A re- inspection fee of ;1.00 will be made when much re-impaction is m.de•neoesaary by improper notice for inspecton, tr malty
materials and /or worlmanship.
that all acts
Il
3 - 2- 6 1 3 /1-6 6
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