Loading...
121 NE 100 St (13)t/ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT goV _ /n�4 Permit No Date..._.._ 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 Registered Architect and /or En gin Plum 3 06 J a u A ti____ N Lz S treet_ ._. � oo - M% "OA t e I!t / f}& 0 p i i 4 Block �✓� Subdtridon.� / S S� IV) •X7 Location an Legal ption Lot �� Street and Number where work is to be performed —No ' Strr State work to be performed and purpose of building (By rs) - e1.&._ __ .•.••.. ..- ..S.. . fEz New Building ._._.___.._.. .... ..... -.. Remodeling _._.__ Addition...- __ —.__ Repairs L ' No. of Stories. ...... Size Septic Tank_._ Type 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 I/ � l� e -G D A Ir (Si 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 5988, Compiled General Laws of Florida Permanent Supplement, and lows com- plied with the provisions thereof, and will require similar compliance from all contra s or sub - contra.. .mployed by him in the work to he performed under this permit; and will post or cause to be posted' for inspection on to of the ork ' • ch public notice or notices as are required by the Act The undersigned agrees to employ only such sub -contr work • under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA. µ COUNTY OF DADE. j 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 be 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. My Commission Expires Notary Public+, State of Florida NOTE: A re inspection fee of $1.00 will be mad. when such Mr wood= is ramis by Improper notice for fnspestioo, or faulty materials and /or workmanship. CLOSETS BATH TUBS LAVA• TORIES SINKS SLOP SINKS LAUNDRY Tuve URINALS CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NS TOTAL F171TURES CONTR. LIST CHICK — _— SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAOI PIT 0 TRAP SOLAR HEATER DIIF WILL BPRKLR. SYSTEM SW IN'0 POOL CONTR. LIST � CHICK t/ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT goV _ /n�4 Permit No Date..._.._ 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 Registered Architect and /or En gin Plum 3 06 J a u A ti____ N Lz S treet_ ._. � oo - M% "OA t e I!t / f}& 0 p i i 4 Block �✓� Subdtridon.� / S S� IV) •X7 Location an Legal ption Lot �� Street and Number where work is to be performed —No ' Strr State work to be performed and purpose of building (By rs) - e1.&._ __ .•.••.. ..- ..S.. . fEz New Building ._._.___.._.. .... ..... -.. Remodeling _._.__ Addition...- __ —.__ Repairs L ' No. of Stories. ...... Size Septic Tank_._ Type 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 I/ � l� e -G D A Ir (Si 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 5988, Compiled General Laws of Florida Permanent Supplement, and lows com- plied with the provisions thereof, and will require similar compliance from all contra s or sub - contra.. .mployed by him in the work to he performed under this permit; and will post or cause to be posted' for inspection on to of the ork ' • ch public notice or notices as are required by the Act The undersigned agrees to employ only such sub -contr work • under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA. µ COUNTY OF DADE. j 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 be 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. My Commission Expires Notary Public+, State of Florida NOTE: A re inspection fee of $1.00 will be mad. when such Mr wood= is ramis by Improper notice for fnspestioo, or faulty materials and /or workmanship.