828 NE 99 St (11)__ - -^
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
IN
SLOP
SINKS
LAUNDRY
TUBE
URINALS
NAL8
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
LIST
-
CHECK
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.: ern -.r. No.__ ..... - - - - --
Owner's Name and Address..
Registered Architect and/
Employing Plumber's Name
Location and Legal Description Lot B
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.
Nature of Water Supply: City -Well.
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date d... C O
Application is hereby matte 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 bg at
building during progress of work.
Repairs No. of Stories
Size Septic Tank. _- .----- __Type of Tank— Capacity Gals.
Feet of Drain Tile -_ + . Feet of Tank or Drain Field from Well. ............ ______
eze. __ _Size of Soakage Pit
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 Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P9�rrinanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contracto&elitployed 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.
( Signed) _.__
., Master Plumber.
STATE OF FLORIDA, } 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.
Notary Public, State of Florida
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 worlcmanship.