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935 NE 99 St (4)Location and Legal Description Lot .___ --__-_______..____....._. Bl Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile._-- - -_{" Nature of Water Supply: City —Well. Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) 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. Owner's Name and Address _ - -- _ ---- -.__._ Street .___...__ Registered Architect and /or Engi eer Employing Plumber's Name _` _ Street_ Subdivision Street State work to be performed and purpose of building (By Floors)___..___ .... ---------___.___----_-----_---- New Building — Remodeling___._ —.._._ Addition____ Repairs No. of Stories .............. ......... _Type of Tank__ Feet of Tank or Drain Field from Well --- _----------- -� - - -- --Size of Soakage Pit Capacity Gals Date - Plumbing inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli tion: as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Penman ' t Su.plement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emp . . . y 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) -- - MasterIP umber. t STATE OF FLORIDA, es. 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 $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. CLC$QrS BATH SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tues UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST i CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWING POOL CONTR. LIST CHECK �� Location and Legal Description Lot .___ --__-_______..____....._. Bl Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile._-- - -_{" Nature of Water Supply: City —Well. Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) 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. Owner's Name and Address _ - -- _ ---- -.__._ Street .___...__ Registered Architect and /or Engi eer Employing Plumber's Name _` _ Street_ Subdivision Street State work to be performed and purpose of building (By Floors)___..___ .... ---------___.___----_-----_---- New Building — Remodeling___._ —.._._ Addition____ Repairs No. of Stories .............. ......... _Type of Tank__ Feet of Tank or Drain Field from Well --- _----------- -� - - -- --Size of Soakage Pit Capacity Gals Date - Plumbing inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli tion: as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Penman ' t Su.plement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emp . . . y 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) -- - MasterIP umber. t STATE OF FLORIDA, es. 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 workmanship.