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1235 NE 100 St (5)Permit No 12 Owner's Name and Address Registered Architect and /or E Employing Plumber's Name_ Location and Legal Description Lot Street and Number where work is to be performed —No New Building � _--__-_ Remodeling_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) 1 7 i Bloolc (Signed)- (Si Date. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitt 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. No. _ Street__ ,_ ? -- Streetlr!_ to Street_ Capacity Gals Nature of Water Supply: City — Well ._____ _ —___ _ _____Size of Soakage Pit My Commission Expires Notary Public, State of Florida Addition.___ Repairs No. of Stories . . ..... .. .... Size Septic Tank_-.___ _ ✓ _Type of Tank_ __ -- Feet of Drain Tile- —75 % ✓ !t is - -- _Dist. Feet of Tank or Drain Field from Well Master Plumber. Plumbing Inspect r. 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 has com- plier 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 s o' the work such ublic otic or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, . n wo to be pe licensed by Miami Shores Village. STATE OF FLORIDA, } 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made •necessary by improper notice for insp . n, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES S INKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHICK - Permit No 12 Owner's Name and Address Registered Architect and /or E Employing Plumber's Name_ Location and Legal Description Lot Street and Number where work is to be performed —No New Building � _--__-_ Remodeling_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) 1 7 i Bloolc (Signed)- (Si Date. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitt 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. No. _ Street__ ,_ ? -- Streetlr!_ to Street_ Capacity Gals Nature of Water Supply: City — Well ._____ _ —___ _ _____Size of Soakage Pit My Commission Expires Notary Public, State of Florida Addition.___ Repairs No. of Stories . . ..... .. .... Size Septic Tank_-.___ _ ✓ _Type of Tank_ __ -- Feet of Drain Tile- —75 % ✓ !t is - -- _Dist. Feet of Tank or Drain Field from Well Master Plumber. Plumbing Inspect r. 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 has com- plier 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 s o' the work such ublic otic or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, . n wo to be pe licensed by Miami Shores Village. STATE OF FLORIDA, } 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made •necessary by improper notice for insp . n, or faulty materials and /or workmanship.