1226 NE 100 St (4)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT 0
305- 795 -2204
Building nspection Request
Date
Type Insp'n - / - t ✓CJ
Permit No. - PL ,00 <4 - 5
Name W
Address / d ` 9 W /v E /00 c r .
Company `7 - '! 6- -eQ' S ( fd G`-:,
Phone# j0S) C' ---' — 3ES
Inspection Date & } r`7
ill
f,„,,
Approved
Correction
Re- Insp'n Fee
D5
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildi g ection Request
Date f° /°il �
Type In sp' n LU 1. i C t3
Permit No. 1 L .
Name C� r (1(105-H
Address / . - ' /J ;
Company il. kt ?of/
/
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
/09 5
Permit No 9 Fr
Application is hereby made for the approval of the detailed statement of tiro plans and specifications here submitted for the building or other
structure herein described. This application is made in compliance and confor may 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 c+s nr't. A copy of approved plans and specifications must be kept at
building during progress of work.
j .y / /1/ 7..L.
Owners Name and Address. . ___!� _ _ . .QC2,/27- e — : - -__ No.. /J.6_.(Gt .._.._ Street 4T, / 749
Registered Architect and /or Engineer f � -? ./_2_4/421__/'___ -_ - S _ ... ' s 'f..--_t
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No Street
Amount of Permit $ --
MIAMI SHORES VIL:,A,GE
PLUMBING INSPECTION DEPARTMEi `:'
APPLICATION FOR PLUMBING
Block_
State work to be performed and purpose of building (By Floors)__-_-_
New Building _._.___________ _______ Remodeling___ ___ Addition
Date_`
/- - -_ - -- — - -- — — - --- (Signed) - — '
No.__._____._.._____ _ Street
Subdivision
Repairs No. of Stories
Type of Tank__ Capacity Gals.
Size Septic Tank
Feet of Drain Tile___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .
Size of Soakage Pit
Plumbing Insppee. 'ter.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his eGligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
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 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.
STATE OF FLORIDA, 1
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
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.
CLOSET6
BATH
TUBS
SHOWERS
LAVA
TORIE6
SINKS
S
SLOP
SINKS
LAUNDRY
TUSB
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
Aar
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LI ST
/
- - --
CHECK
Permit No 9 Fr
Application is hereby made for the approval of the detailed statement of tiro plans and specifications here submitted for the building or other
structure herein described. This application is made in compliance and confor may 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 c+s nr't. A copy of approved plans and specifications must be kept at
building during progress of work.
j .y / /1/ 7..L.
Owners Name and Address. . ___!� _ _ . .QC2,/27- e — : - -__ No.. /J.6_.(Gt .._.._ Street 4T, / 749
Registered Architect and /or Engineer f � -? ./_2_4/421__/'___ -_ - S _ ... ' s 'f..--_t
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No Street
Amount of Permit $ --
MIAMI SHORES VIL:,A,GE
PLUMBING INSPECTION DEPARTMEi `:'
APPLICATION FOR PLUMBING
Block_
State work to be performed and purpose of building (By Floors)__-_-_
New Building _._.___________ _______ Remodeling___ ___ Addition
Date_`
/- - -_ - -- — - -- — — - --- (Signed) - — '
No.__._____._.._____ _ Street
Subdivision
Repairs No. of Stories
Type of Tank__ Capacity Gals.
Size Septic Tank
Feet of Drain Tile___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .
Size of Soakage Pit
Plumbing Insppee. 'ter.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his eGligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
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 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.
STATE OF FLORIDA, 1
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
PERMIT 11T° 2685
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
B1
Subdi-
vision
Value of
Project $
DATE
Contractor's
License No.
Amount of
Permit $
/
MONISM
195 5
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 application
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 responsibility for work
done by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY ®ate'
Permit No a ' '°
Application is hereby made for the approval of the detailed statement of th;; 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 ar not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ' � eerz: ° `i 7 ` -- "‘C , ' No._L. __.7 __ & Street-_ -J c G= / t
Registered Architect and /or Engineer___-, _ _______ __ ____
Employing Plumber's Name s / l 4 ,---- ' -1, ' _____.__ No.
Location and Legal Description Lot__ _____- _ _ . _ __ _____ Block
Street and Number where work is to be performed- No..._____— _______ —_ _ _ . _ Street.
State work to be performed and purpose of building (By Floors)--
New Building _ -- Remodeling---- __--------- _- _ - -___ Addition------- _._._ -_ -- - - -_ -. Repairs 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 - ell. a Size of Soakage Pit
Amount of Permit $
MIAMI SHORES VIL AGE
PLUMBING INSPECTION DEPARTMEo <';
APPLICATION FOR PLUMBING MrT
(Signed)
Date 1G!
Street._. _ . — - - - -•--
Subdivision -
Capacity Gals
Master Plumber.
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.
(Signed)
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 Permanent Supplement, and bus com-
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 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.
rJ
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
INK
SLOP
SINKS
LAUNDRY
TUBS
R INALS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKI
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
Permit No a ' '°
Application is hereby made for the approval of the detailed statement of th;; 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 ar not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ' � eerz: ° `i 7 ` -- "‘C , ' No._L. __.7 __ & Street-_ -J c G= / t
Registered Architect and /or Engineer___-, _ _______ __ ____
Employing Plumber's Name s / l 4 ,---- ' -1, ' _____.__ No.
Location and Legal Description Lot__ _____- _ _ . _ __ _____ Block
Street and Number where work is to be performed- No..._____— _______ —_ _ _ . _ Street.
State work to be performed and purpose of building (By Floors)--
New Building _ -- Remodeling---- __--------- _- _ - -___ Addition------- _._._ -_ -- - - -_ -. Repairs 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 - ell. a Size of Soakage Pit
Amount of Permit $
MIAMI SHORES VIL AGE
PLUMBING INSPECTION DEPARTMEo <';
APPLICATION FOR PLUMBING MrT
(Signed)
Date 1G!
Street._. _ . — - - - -•--
Subdivision -
Capacity Gals
Master Plumber.
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.
(Signed)
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 Permanent Supplement, and bus com-
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 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.
rJ
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No
Disapproved
(Signed)
ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval 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.
\ M AA Date / J ._ 3 a .55 , 19
Owner's Name and Address.. 1'�+�e No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done _ LQ i/
State work to be done and purpose of building (by floors)
^° 2 • -' and for no other purpose.
Repairs No. of Stories
Kind of foundation Roof Covering
New Building Remodeling
To be constructed of
Estimated Total cost of improvements $
Addition
Amount of Permit $
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
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
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida, Permanent 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
pennit, as are licensed by Miami Shores Village.
Remarks (Signed) C � " ' ' e
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.
Date 1/- / � � Read, Sworn to and Subscribed before me.
ate
icy
ing Inspector My Commission Expires
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE, FLORIDA
Owner of
Building
BUILDING ❑ DATE / 7 = 195
ELECTRICAL ❑ PERMIT N° 15496 Contractor's
PLUMBING 04:1 License No
ROOFING ❑ Work to be performed under this Permit
..,
1 - S. c i ,.
Architect j -�
Contractor
or Builder
Legal Lot il Bl Subdi-
Description vision
Address of Value of I Amt. of
Building t ;'._ 'i L ! ° "'4 -.....,-c4k Project $ Permit $ / "'_,�,,,,
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 application
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 drawin s or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. /
Signed • �, r .. l i ti BY l . c " .- 1 --'- ._
Y INSPBCTOR
In consideration of the issuance to me of this permit I agree to pekform the work covered hereunder in complianc with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, state tits or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit 4 assume responsibility for all work done by either, myself, my agent, servant or employee.
r 1
r - s - t
OONTRACTOR OR BUILDER
BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA ,
❑ DATE �' �✓� 1953_
ROOFING ❑ Work to be performed
Owner of
Building
PERMIT N° 15370
This permit is granted to the contractor or builder named above to construct
herefor in strict compliance with all ordinances—pertaining thereto and with
drawings, statements or specifications that may have been submitted to and
'me if the work is not done.in compliance with such ordinances or if the pl
a nted is the understanding that the contractor-04 builder na hove a
ne by his agents, servants or employees.
rtaining to the cork covered hereby whether show2r • " dra
In consideration of the issuance to me this permit
taining thereto and in strict conformity with the dr
accepting this permit I assume respo4sibility for all
•
CONTRACTOR,. OR BUILDER
under this Permit
n • erst
proved by the pro
s are change
mes the responsibility
gs or in the
Sig ed:
BY
Contractor's
License No
Amt. of
Permit
uilding or to install the equipment or device described in the appll!ation
a that the work will be performed in compliance with any plans,
. r municipal authorities. This Permit may be revoked at any
d without : uthorization. A further condition upon which this permit is
or a thorough knowledge of the ordinances and regulations
teme or specifications and that he assumes r •onsibility for work
INSPECTOR
I a . ee to perform the work covered hereunder in compliance with all o inances and regulations
gs, statements or specifications submitted to the proper authorities o Miami Shores Village.
done by either, my my agent, servant or employee.
•
AUTHORITY
Permit No. 1 -
My Commission Expires
MIAMI SHORES VILLAGE
' PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby node for the approval of the detailed statement of the plans and specifications herewith submitted for the building or of in
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 Divisior
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 Enginyer rr
/ _ _ sue A . n
Employing Plumber's Name e, No. L Street = - ...' / o_ !i:
Location and Legal Description Lot__ _ Block+_ —_ __ -___ -- - - _ -_ - -- Subdivision__ 'A' t - t k4- -, a
Street and Number where work is to be perfo d—No _ _.�'.- ._ _ /✓ ii street / ® \
State work to be performed and purpose of building -F1oors)
ell .
Amount of Permit $_ ...... _____ - -• -
New Building L. Remodeling Addition.--------------- __ -_.. Repairs. - -- -...._ . -• - -._ -- No. of Stories / .. .... .
Size Septic Tank Type of Tank_ -_ Capacity Gals.
Feet of Drain Tile
Nature of Water Sup
Dist. Feet of Tank or Drain Field from Well
.— Size of Soakage
(Si — —
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify tha _ : 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, and has com-
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 notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on wor to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)._
Date .. -
Master Plumber.
STATE OF FLORIDA, ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 name, and that all tac
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 f:lul
materials a /or workmanship.
CLOSITO
BATH
TUBS
SHOWIRO
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tulle
URINALS
CATCH
SABIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
f- ,e Ffe 1
ld /
A I
1 /
� M C
�
TOTAL
FIETUR[I
_L
LIST
CHECK
3
1
-.1...-......
_
Z'
\
16
g
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DRIP
WILL
SPRKLR.
SYSTEM
SWIM'O
POOL
4 , vt J� t
111 ��•
.
CONTR.
LIST
CHICK
—T.-
,
-
50
,t
Permit No. 1 -
My Commission Expires
MIAMI SHORES VILLAGE
' PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby node for the approval of the detailed statement of the plans and specifications herewith submitted for the building or of in
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 Divisior
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 Enginyer rr
/ _ _ sue A . n
Employing Plumber's Name e, No. L Street = - ...' / o_ !i:
Location and Legal Description Lot__ _ Block+_ —_ __ -___ -- - - _ -_ - -- Subdivision__ 'A' t - t k4- -, a
Street and Number where work is to be perfo d—No _ _.�'.- ._ _ /✓ ii street / ® \
State work to be performed and purpose of building -F1oors)
ell .
Amount of Permit $_ ...... _____ - -• -
New Building L. Remodeling Addition.--------------- __ -_.. Repairs. - -- -...._ . -• - -._ -- No. of Stories / .. .... .
Size Septic Tank Type of Tank_ -_ Capacity Gals.
Feet of Drain Tile
Nature of Water Sup
Dist. Feet of Tank or Drain Field from Well
.— Size of Soakage
(Si — —
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify tha _ : 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, and has com-
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 notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on wor to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)._
Date .. -
Master Plumber.
STATE OF FLORIDA, ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 name, and that all tac
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 f:lul
materials a /or workmanship.
.'•
/ . �� �� •
~ e -` . •,
°
.�
�