1249 NE 100 St (6)Size Septic Tank__-------- -
Feet of Drain Tile.
—
Nature of Water Supply: City—Weil.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No...Z.7/ff, Date..._ '-t el _.. - - -• •_ -•• — 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. II
Owner's Name and Address
hilic - fo ' N 1;241
Registered Architect and /or Engineer
£at 1 y�1 l / '�s N '�o P")45414 ...., Na. // " tg `'andf' gar D4•'4'pti
ot_ j � � / mock_ Subdivision
Street and Number where work is to be performed —No i 24 t Street. ._.. _�.._... 1 _
State work to be performed and purpose of building (By Flo ra)__.C.r _. .__LP._:._ COvr�C -
New Building.._..._.— _.._. ..... ...._.. Remodeling__ _. -- Addition.. -- - - -• -- - Repairs 1 No. of Stories
_Type of Tank—_ _____Dist. Feet Feet of Tank or Drain Field from __---•---..__._...
Size of Soakage Pit
Amount of Permit $ oO (Signed)_ t v ` _. s^.�
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 5968, Compiled General Laws of Florida Permanent Supplement, and hax corn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort• to lie
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 errr
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)
5S S° 5Z° (OW
CerzY. . �z)< 14%S
Street.. IW 6 i._
Plumbing Inspector.
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the t that all facts
of the above described construction, that be has carefully read the foregoing application, sign the same, and
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made wham mob r♦iespaotiaa i. snada•aaoaseery by improper notice for inspection, or faulty
materials and /or worl®aasbip.
CLO$ET$
BATH
Tu.•
SNOWERF
LAVA.
TORILF
SINKS
SLOP
SINKS
LAUNDRY
Tug•
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'N•
I TOTAL
I PIIITURES
CONTR.
LIST
CHICK
-
1
+
SEPTIC
TANK
SEWER
CONN.
GRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
our
WELL
SPRKLR.
SYSTEM
SW IM•O
POOL
yy
I
i
�—
CON'TR.
LIFT
CHECK
Size Septic Tank__-------- -
Feet of Drain Tile.
—
Nature of Water Supply: City—Weil.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No...Z.7/ff, Date..._ '-t el _.. - - -• •_ -•• — 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. II
Owner's Name and Address
hilic - fo ' N 1;241
Registered Architect and /or Engineer
£at 1 y�1 l / '�s N '�o P")45414 ...., Na. // " tg `'andf' gar D4•'4'pti
ot_ j � � / mock_ Subdivision
Street and Number where work is to be performed —No i 24 t Street. ._.. _�.._... 1 _
State work to be performed and purpose of building (By Flo ra)__.C.r _. .__LP._:._ COvr�C -
New Building.._..._.— _.._. ..... ...._.. Remodeling__ _. -- Addition.. -- - - -• -- - Repairs 1 No. of Stories
_Type of Tank—_ _____Dist. Feet Feet of Tank or Drain Field from __---•---..__._...
Size of Soakage Pit
Amount of Permit $ oO (Signed)_ t v ` _. s^.�
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 5968, Compiled General Laws of Florida Permanent Supplement, and hax corn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort• to lie
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 errr
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)
5S S° 5Z° (OW
CerzY. . �z)< 14%S
Street.. IW 6 i._
Plumbing Inspector.
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the t that all facts
of the above described construction, that be has carefully read the foregoing application, sign the same, and
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 wham mob r♦iespaotiaa i. snada•aaoaseery by improper notice for inspection, or faulty
materials and /or worl®aasbip.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
'Contractor
or Builder
Legal
Description
❑ PERMIT N° 9645
Vim.
Address of
Building 1 ilo• T1
MIAMI SHORES VILLAGE,
This permit is granted to the contractor or builder named above
herefor in strict compliance with all ordinances pertaining thereto and
drawings, statements or specifications that may have been submitted to
time A the work is not done in compliance with such ordinances or 0 th
granted is the understanding that the contractor or builder named abo
pertaining to the work covered hereby whether shown on the plans or
done by his agents, servants or employees.
Signed.
In consideration of the issuance to me of this pe
pertaining thereto and in strict conformity with the plans, dra
In accepting thi4 p t„,„I-s ume responsibility for all work done
Subdi-
vision
Value of
Project $
FLORID
DATE €
Contrac
Lice
INSPECTOR
rform the work covered hereunder in comp ' .. with all o
eats or specifiati submitted to the proper authorities o
they, myself, m ,,savant or employee.
195
Amt. of
Permit
to construct the building or to install the equipment or device described in the application
with the undorstancTink,that the work will be performed in compliance with any plans,
11 approved by the proper municipal authorities. This Permit may be revoked at any
plans are anged wi ut authorization. A further condition upon which this permit is
assumes respo ility for a thorough knowledge of the ordinances and regulations
rawinsa.a,t tcrosttts or ..; ' 'cations and , _ . • nubility for work
finances and regulations
Miami Shores Village.
y/Y
<:,
4
BUILDING
ELECTRICAL
PLUMBING
,
Lot
CONTRACTOR OR
MIAMI SHORES VILLAGE, FLORIDA
DATE `. - f 195
Cq actor's
License No
PERMIT N? . 9436
Work to a performed under this Permit
Owner of ( j L
Building JJJ1
Architect
'Contractor
or Builder
Legal
Description-
Address of
Building
m
Signed:
In consideration of the issuance to me of this permit I agree to
pertaining thereto and in strict conformity with the plans, drawings,
In accepting this permit I assume responsibility for all work done
Subdi-
vision
Value of
Project $
u
Amt. of
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 0 the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition uppoonn which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the or and regulations
pertaining to the work covered hereby whether shown on the plans or d wings or • the statements .r specifications and that he assumes responsibility for work
done by his agents, servants or employees.
ordinances and regulations
of Miami Shores Village.
` Permit No /
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
— — ---a
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____ , u _a_: r:, � No Street /.�!! L/ ‘: f
Registered Architect and /or Engineer
Employing Plumber's Name L'�1
in (- L No Street
Location and Legal Description Lot Block Subdivision
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 iI C Type of Tank Capacity Gals
Feet of Drain Tile__________1 Q 2 Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
( Signed)
C''
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 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.
(igned)--- + ..,...
. -t r
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
` Permit No /
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
— — ---a
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____ , u _a_: r:, � No Street /.�!! L/ ‘: f
Registered Architect and /or Engineer
Employing Plumber's Name L'�1
in (- L No Street
Location and Legal Description Lot Block Subdivision
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 iI C Type of Tank Capacity Gals
Feet of Drain Tile__________1 Q 2 Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
( Signed)
C''
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 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.
(igned)--- + ..,...
. -t r
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.
Date '
r
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 applic 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.
Permit No.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name / 4/ u',"re PL -An
.. f 7 r
Location and Legal Description Lot____ 1 � ;,, t_i._____________��_-____7_____ Block__
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)"
New Building Remodeling Addition Repairs
Size Septic Tank___— Type of Tank Capacity Gals.__
Feet of Drain Tile
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
Dist. Feet of Tank or Drain Field from Well
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
__1 A 4' No Street
No Street
Subdivision__«^
Street G
(Signed)
No. of Stories
l /
The undersigned applicant for this building permit does hereby certify that he understbnds and accepts his obligations , an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su lement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe 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)
My Commission Expires Notary Public, State of Florida
/ ; 1
robing Inspector.
- - - --
Master - pber. - -
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 inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Date '
r
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 applic 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.
Permit No.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name / 4/ u',"re PL -An
.. f 7 r
Location and Legal Description Lot____ 1 � ;,, t_i._____________��_-____7_____ Block__
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)"
New Building Remodeling Addition Repairs
Size Septic Tank___— Type of Tank Capacity Gals.__
Feet of Drain Tile
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
Dist. Feet of Tank or Drain Field from Well
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
__1 A 4' No Street
No Street
Subdivision__«^
Street G
(Signed)
No. of Stories
l /
The undersigned applicant for this building permit does hereby certify that he understbnds and accepts his obligations , an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su lement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe 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)
My Commission Expires Notary Public, State of Florida
/ ; 1
robing Inspector.
- - - --
Master - pber. - -
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 inspection, or faulty
materials and /or workmanship.
Permit No 2
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
No Street
X" •�•�
Registered Architect and /or Engineer � `r ( '___ 4 - ?-t - 4_L� 4 / ti
Employing Plumber's Name . -x.. _2, 4- - .L� -,- - `':Ld._t.. . " " _ ' le ' No.- - .,--1' `, ei .e . ... ;
Location and Legal Description LotW v__ P__L_rzl 261. i 6 Block f Subdivision__ ..1 t , (f �+
Street and Number where work is to be performed— No._ _J_. 7 _ Street /
State work to be performed -
and purpose of building (By Floors) � -''4'
New Building ____________ _______ Remodeling Addition____ Repairs No. of Stories___
Amount of Permit $ -___(1 • Z
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
Capacity Gals.
- ---------------
( Signed-------- - -_r_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig !dins as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm 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.
(Signed) ._
Date
er' r� • '
Plumbing Inspector.
STATE OF FLORIDA, ( ss.
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 nee 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
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
LIST
�_
!
///
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
,
V •••A
W M
CONTR.
LIST
/
/
/
'
CHECK
Permit No 2
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
No Street
X" •�•�
Registered Architect and /or Engineer � `r ( '___ 4 - ?-t - 4_L� 4 / ti
Employing Plumber's Name . -x.. _2, 4- - .L� -,- - `':Ld._t.. . " " _ ' le ' No.- - .,--1' `, ei .e . ... ;
Location and Legal Description LotW v__ P__L_rzl 261. i 6 Block f Subdivision__ ..1 t , (f �+
Street and Number where work is to be performed— No._ _J_. 7 _ Street /
State work to be performed -
and purpose of building (By Floors) � -''4'
New Building ____________ _______ Remodeling Addition____ Repairs No. of Stories___
Amount of Permit $ -___(1 • Z
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
Capacity Gals.
- ---------------
( Signed-------- - -_r_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig !dins as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm 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.
(Signed) ._
Date
er' r� • '
Plumbing Inspector.
STATE OF FLORIDA, ( ss.
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 nee 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
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.
_
:.