1234 NE 101 StBUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
Date C—
ELECTRICAL ❑ �j p
PLUMBING ❑ PERMIT N 10748 Contractor's
ROOFING ❑ License No. 45,40,( 3 3
❑ work to be performed under this Permit
Owner of t1 ' ��! � t �'"
Building L)' !:- F-1 ,E4i O ••, , C:7 C ii v c 1 • / , C- (n± J_1 t
Architect 1 k' e- i /1 /r.4 SACS J 1k. r.t"., ( t (
.4
Contractor j r _4,. z ---4 - {4 `
or Builder _ - i C G3 C `�-�. j ✓
Legal Lot
Description
Address of
Building
3
CONTRACTOR or BUILDER
,_t
•►#
/o1
t
J
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or dryings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or efpployees
,/ / 1
Signed a-' # L. ' i — ** (I ISPECTOR) BY
In consideration of the issuance to me of this permit I agree to rform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, s ements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by' either, myself, my agent, servant or employee.
Subdi-
vision
Sq Ft
Value of ¢i I I Amount of
Project $ /CPS 11 Permit $
BY
AUTHORITY
19_.4)
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL 111 Date 2- �Z �7 19 r"'r
PLUMBING ❑ PERMIT N? 10712 Contractor's V f)
ROOFING ❑ License No.
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
GAT.... ,,rr,�
fa-3•i Ai 4:- 101*S
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants.or employe
Signec /O - (INSPECTOR) BY
CONTRACTOR or BUILDER
In consideration of the issuance to me of this permit I agree
pertaining thereto and in strict conformity with the plans, drawings
In accepti[(g this permit I assume responsibility for all work done
i 1 � �f
/
Work to be performed under this Permit
s in cU.__.
II Bl
r•
Subdi-
vision
Sq. Ft.
Value of 11 Amount of '?
Project $ 11 Permit $
perform the work covered hereunder in compliance with all ordinances and regulations
tements or specifications submitted to the proper authorities of Miami Shores Village.
either, myself, Ay agent, serva t�
f /
BY
AUTHORITY
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑ 1 C
PLUMBING ® PERMIT N? 10561 Contractor's e 3
License No.
ROOFING ❑
Owner of
Building
Architect
Vt
0
T t.
ork
+t r i
Contractor
or Builder ' i 7 ln L+ e/ ca..•:.$ 4 S
Legal Lot /
3
Description
Bl
BBuldingof ; : S �! jsl /v , t
CONTRACTOR or BUILDER
Date
to be performed under this Permit t-
1
BY
l
[ Jv
C. • , v t„
%<<
5 4' F .r /, ■.■ 6 .: pi
Subdi-
vision corms v is •
Sq. Ft.
Value of I Amount of
Project $ I I Permit $ 1
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shpwn on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servant or' tploye s. /
/ .1 !
Signed • --. h%PECTOR) BY
In consideration of the issuance to me of this permit I agree 'perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawing statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work don by either, myself, my agent, servant or employee.
t•1 rALi't /i i C..j
AUTHORITY
Iw�� 1
BUILDING 1A
ELECTRICAL ❑ Date Pi"' " 1945"
PLUMBING ❑ PERMIT N? 10560 Contractor's
ROOFING ❑ License No 0 33
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
C+ 4. 414.-/i" M A T T 4 A s
J . - t C , T r
.'1 - ►
�. 4. - 2.a t 1& 3 a
T A (... 4 t•
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with and
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servant s gr emplo es.
Si ned • [J � •
( - . , i
g � - 41 "`*NSPECTOR) BY
In consideration of the issuance to me of this permit I ag to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawi , statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work d.ne by either, myself, my agent, servant or employee.
•
A , _
CONTRACTOR or BUILDER BY AUTHORITY
MIAMI SHORES VILLAGE, FLORIDA
❑ Work to be performed under this Permit IL . J r .. + ( f)4.
Lot 3
Bl.
I '3 el •l c. 10
1
J7r
Gtr ?' 4f, (..) 7
Tc
Subdi-
vision O'' -, <'>. S 1 c. ! -
Sq Ft
Value of ‹: -1 O P r
..- 11 Amount of - 2. a
Project $ co s II Permit $
Permit No "
Owner's Name and Address
State work to be perfor
New B>sg
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. I
� � /- /C o
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/p e'
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, Flgrida,
and all provisions of the Laws of the Stat of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be co . le• w •herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engine
Employing Electrician's Name...
Location and Legal Description Lot Block
Street and Number where work is to be performed —No l�
a-16 e:2 [„l No Street 3 /O
........ Addition
ss.
d an purpose of building (By Floors)
Repairs No. of Stories
/'Service Size Feeders Conduit Main Sw Amps Main Fuses Amps
' Underground
_ T'y of Installation— Conduit Tubing B.X.L Metal Moulding
(Signed)
(Signed)
Date
No Street.. . . /a/ 4
Subdivision
). / e / i_ Zfeite
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to
licensed by Miami Shores Village.
-r7 c
Electrical Inspector.
ccepts his obligations as qt employer of
of Florida Permanent plement, and
subcontractors employe by him in the
of the work such public notice or notices
be performed under this permit, as are
Master Electrician.
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, and he has carefully read the foregoing application, and that he 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 made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUO
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
2
CHECK
/
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
,`11....3 HHPP� /q
• / ! /
NEON
' TRANS
[x�
�
RADIO
C---�-
TOTAL
CONTR.
LIST
/ jY
/
CHECK
Permit No "
Owner's Name and Address
State work to be perfor
New B>sg
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. I
� � /- /C o
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
/p e'
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, Flgrida,
and all provisions of the Laws of the Stat of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be co . le• w •herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engine
Employing Electrician's Name...
Location and Legal Description Lot Block
Street and Number where work is to be performed —No l�
a-16 e:2 [„l No Street 3 /O
........ Addition
ss.
d an purpose of building (By Floors)
Repairs No. of Stories
/'Service Size Feeders Conduit Main Sw Amps Main Fuses Amps
' Underground
_ T'y of Installation— Conduit Tubing B.X.L Metal Moulding
(Signed)
(Signed)
Date
No Street.. . . /a/ 4
Subdivision
). / e / i_ Zfeite
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to
licensed by Miami Shores Village.
-r7 c
Electrical Inspector.
ccepts his obligations as qt employer of
of Florida Permanent plement, and
subcontractors employe by him in the
of the work such public notice or notices
be performed under this permit, as are
Master Electrician.
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, and he has carefully read the foregoing application, and that he 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 made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
JOB DATA
BUILDING ELECTRICAL
PERMIT NO. PERMIT NO . ,
TYPE
NUMBER
FEE
OUTLETS, ROUGH WIRING
•-+'"
DATE
CONTRACTING FIRM s -: .
SERVHyE CAPACITY
CONTRACTOR'S ADDRESS �^,' / .: . 2 , -- PHONE ' . /7 , ',.
RANGE
SLAB
RANGE TOP
OWNER'S NAME PHONE
< <;
RECESSED OVEN
ROUGH
JOB ADDRESS ,e
DRYER
AIR CONDITIONER (WINDOW)
LOT BLOCK
AIR CONDITIONER (PACKAGE)
SUBDIVISION
MOTORS" • LIST BELOW
t
/ /l . >jr
WATER HEATERS
CLOTHES WASHER
DISHWASHER
Application is hereby mode to obtain a permit to do the work and installations as
hereon indicated. I certify that no such work or installation has been effected
prior to the isseeno, af++auio•.ewwitand that all work will b• -performed to meet
the standards of all laws regulating construction in D'Sde County, I further certify
that I have checked and am responsible for the adequacy of any waving wiring
systems to which the work described in this permit odds extension or makes
changes.
r ,.
PERMANENT FANS
SPACE HEATER
DISPOSAL
NUMBER OF LAMPS
MASTER ELECTRICIAN OR HOME OWNER
INSURANCE DATE ISSUED BY:
This permit does not become valid until signed by an authorized representotive
of the Director, Metropolitan Dade County Building and Zoning Deportment and
oII fees are paid and receipt acknowledged in the space provided.
TEMPORARY SERVICE
REINSPBCTION
TOTAL FEE imimmn> 1 *1 ../..:/`
LIST OF MOTORS
PROPOSED USE OF BUILDING
No.
Some Floor
Feo.
No.
A.C.
Fee
NO. OF STORES FAMILIES METERS
OFFICES BEDROOMS
BUILDING INFORMATION: OLD NEW 0
TYPE-OF WORK ADD NEW ALTER. REPAIR 0
L i FIELD CHECK REQUIRED
APPLICATION APPROVED BY
FINAL INSPECTION MADE
DATE
ELECTRICAL INSPECTOR
O.K. TO CONNECT YES NO
REMARKS:
NOTE:
123.03.8
METROPOLITAN DADE COUNTY
BUILDING and ZONING 1351 N.W. 12th ST.
BOX 52 -655 MIAMI, FLORIDA 33125
ELECTRICAL PERMIT APPLICATION
INSPECTOR'S REPORT
Electrical Inspections
List under 'REMARKS' above the dote and type of all noticalleft, all verbal instruction_;, t4 ths_ contractor, and any
other information pertinent to the inspection of this job.
APPLICANT'S COPY
FOR OFFICE USE ONLY
APPROVED
DISAPPROVED
NAME
DATE
NAME
DATE
REASON
TEMPORARY
SLAB
ROUGH
OTHER
REMARKS:
NOTE:
123.03.8
METROPOLITAN DADE COUNTY
BUILDING and ZONING 1351 N.W. 12th ST.
BOX 52 -655 MIAMI, FLORIDA 33125
ELECTRICAL PERMIT APPLICATION
INSPECTOR'S REPORT
Electrical Inspections
List under 'REMARKS' above the dote and type of all noticalleft, all verbal instruction_;, t4 ths_ contractor, and any
other information pertinent to the inspection of this job.
APPLICANT'S COPY
FOR OFFICE USE ONLY
/.c 0 /
a s
PE?
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Disapproved
(Signed)
Owner's Name and Address - (C TOR_ %? c___N_I_ ir_[__ /7
te_
Chairman
Member
Member
Registered Architect and Engineer ___. 176 g. 5
Name and address of licensed contractor L_ /1l d' 4) C
Location and legal description of lot to be built on:
Lot Block
Date. _. ® — 2 5- , 19X
No.I 2 ' 3 ` ( Street_. E / 0/ 5r 5r2c e i
Subdivision apLL_ .1?_ F N 5 /-1D,-� S
Street and Number where work is to be done 1 Y 3 _ N E .( t C
State work to be done and purpose of building (by floors) 1!%✓ 1 N1 i N G Po z _ , 14,
and for no other purpose.
New Building ,- Remodeling Addition Repairs No. of Stories
To be constructed of_ N eciv Kind of foundation Roof Covering
Estimated Total cost of improvements $.__ -530 0 , ... -- Amount of Permit $
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot 7° r ,x 1 ' S' 7 8 /
Maximum' live load to be borne by each floor__ _... -
I hereby submit all the plans and specifications for said building. All notices with reference to the•building and its construction may
be sent to - a'-- __- _ -S-L✓ S I l ew/a • -% M1 1 `1‘3
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, Pennanent Supplement,
and has complied 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. �j�
Remarks (Signed) �uf
/r- s S ;
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No �' Date.___..1 ®' Z �� Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building I.s, pector My Commission Expires
PLANNING BOARD ._ DATE
Member
Member
Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
' materials and /or workmanship.
^
CHECK
SEPTIC SEWER DRAIN SOAKAGE GREASE SOLAR DEEP SPRKLR. SW IM'G
TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL
CONTR. (/ ,— / --
LIST !/
e---- -
CHECK
Permit No _
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Div ;sion
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. .._.__ __.1 C -�� -- _ /
� � / '1 Ti2A Nof_?�✓ - - -__ - -_ - -_ Street. /v.6._ /. a / 5 - ..57 �� r
__
L �!
Registered Architect an or Engi p r _ . n . /17'v-4 .
Employing Plumber's Name _ -- -- --.1� ! _L �.-'� C , — - _ No._ _ _- -- ___ - -- . _ Street _ - - . -_-
Location and Legal Description Lot ____.__ mi l ___ . -• --- --- Block_ _ % Subdivision -60— ° 5 /f s $
d
Street and Number where work is to be performed -No / Z 3 >' d1/ e _ Street_ " 4C /.. 5 �- �- T
State work to be performed and purpose of building (By Floors)_ /�V / �N . �a'�
New Building — ____ -- - • -- - _ - -___ Remodeling —___ __- -- -- -- - Addition_--- . _ -.- __ -- ... _ Repairs_ _ . _ -- No. of Stories . .. _ .. .
co
Amount of Permit $ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Capacity Gals.
Size Septic Tank__ _ _ -- lype of "IanK ___ ---- _ -- _ . - _ •_. ._ - -- _
Feet of Drain Tile____ _ __ -_ _Dist. Feet of Tank or Drain Field from Well.- ._ ___
Nature of Water Supply: City -Well. ___. __ __ _ _ . _ __ Size of Soakage Pit
legr1=PC+1(==24€1.
Date _ / 4
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 Permanent Supplement, rnd I as ^cmi-
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 no"Ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. - ed under this per nit, as are
licensed by Miami Shores Village.
(Signed )-
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acllnowledgn ents, personal) 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 .acts
therein by him stated are true.
My Commission Expires Notary Public, State oaf Florida
PLmbsng In:pecto.
Master Plumber.
NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is nude •necessary by improper notice for inspection, or faulty
materials and /or worinnanship.
CLOSETS T
BATH L
SHOWERS
LAVA- S
SINKS S
SLOP L
LAUNDRY U
URINALS C
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
LIST
Permit No _
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Div ;sion
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. .._.__ __.1 C -�� -- _ /
� � / '1 Ti2A Nof_?�✓ - - -__ - -_ - -_ Street. /v.6._ /. a / 5 - ..57 �� r
__
L �!
Registered Architect an or Engi p r _ . n . /17'v-4 .
Employing Plumber's Name _ -- -- --.1� ! _L �.-'� C , — - _ No._ _ _- -- ___ - -- . _ Street _ - - . -_-
Location and Legal Description Lot ____.__ mi l ___ . -• --- --- Block_ _ % Subdivision -60— ° 5 /f s $
d
Street and Number where work is to be performed -No / Z 3 >' d1/ e _ Street_ " 4C /.. 5 �- �- T
State work to be performed and purpose of building (By Floors)_ /�V / �N . �a'�
New Building — ____ -- - • -- - _ - -___ Remodeling —___ __- -- -- -- - Addition_--- . _ -.- __ -- ... _ Repairs_ _ . _ -- No. of Stories . .. _ .. .
co
Amount of Permit $ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Capacity Gals.
Size Septic Tank__ _ _ -- lype of "IanK ___ ---- _ -- _ . - _ •_. ._ - -- _
Feet of Drain Tile____ _ __ -_ _Dist. Feet of Tank or Drain Field from Well.- ._ ___
Nature of Water Supply: City -Well. ___. __ __ _ _ . _ __ Size of Soakage Pit
legr1=PC+1(==24€1.
Date _ / 4
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 Permanent Supplement, rnd I as ^cmi-
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 no"Ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. - ed under this per nit, as are
licensed by Miami Shores Village.
(Signed )-
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acllnowledgn ents, personal) 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 .acts
therein by him stated are true.
My Commission Expires Notary Public, State oaf Florida
PLmbsng In:pecto.
Master Plumber.
NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is nude •necessary by improper notice for inspection, or faulty
materials and /or worinnanship.