270 NE 100 St (9)JOB:
BUILDING
ELECTRICAL
PLUMBING
ey
f
/-
WORK
DONE BY �,''i,.
, �'
REQUESTED
•
•
•
•
The following is ready for Inspection: -
Inspector's Report: -
WILL BE READY
P
•
•
•
JOB: AD:
BUILDING
ELECTRICAL
PLUMBING
Inspector's Report: -
•
• • WORK
• DONE BY
•
• REQUESTED
•
•
The following is ready, for Inspection:
•
•
•
• •
WILL BE READY
Architect
Contractor
or Builder
Legal Lot . •, Bl.
Description
Address of
Building
•
BUILDING
ELECTRICAL
PLUMBING
Owner of .
Building J
Work to be performed under this Permit f'
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
ERMIT N9 1694
Subdi-
vision
Value of
Project
BY
DATE = 194
Contractor's
License No
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 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• ; w B
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform thk work covered hereunder in compliance with all ordinances and regula-
tions p aining thereto and in strict conformity with the plans, drawings, stat1ents or specifications submitted to the proper authorities of Miami Shores
Villain accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Buulder
Legal
Description
Address of
'iflding
Lot
rr r
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 1494
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project
DATE 194
Contractor's
License No.
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
pplication 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 regula-
ions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
tillage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
(
CONTRACTOR OR BUILD BY AUTHORITY
•
Permit No.
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
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.
State work to be performed and purpose of building (By Floors) _— _
Amount of Permit $_ *moo" (Signed)
New Building Remodeling Addition
Date__
' Street. 1 6'C)
Owner's Name and Address �� �t , r,, �-
Registered Architect and /or Engineer `+ -4.4 y A lil , "L_ ' 1 Edi
Employing Plumber's Name No._CP / / H! C '
Location and Legal Description Lot N Block__...T___ Subdivision
Street and Number where work is to be performed —No �i : _ 7 O "tie Street 0 ' > f
Street____V
Repairs
(Signed)
Notary Public, State of Florida
- Ir
4
No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that fie 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-
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 under signed agrees to employ only such sub - contractors, on work to be performed andj 4 is permit, a are
licensed by Miami Shores Village.
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
Tuns
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.
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
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.
State work to be performed and purpose of building (By Floors) _— _
Amount of Permit $_ *moo" (Signed)
New Building Remodeling Addition
Date__
' Street. 1 6'C)
Owner's Name and Address �� �t , r,, �-
Registered Architect and /or Engineer `+ -4.4 y A lil , "L_ ' 1 Edi
Employing Plumber's Name No._CP / / H! C '
Location and Legal Description Lot N Block__...T___ Subdivision
Street and Number where work is to be performed —No �i : _ 7 O "tie Street 0 ' > f
Street____V
Repairs
(Signed)
Notary Public, State of Florida
- Ir
4
No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that fie 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-
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 under signed agrees to employ only such sub - contractors, on work to be performed andj 4 is permit, a are
licensed by Miami Shores Village.
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.
JOB: ? , AD:
BUILDING
ELECTRICAL
PLUMBING
•
•
• • WORK
• • ▪ DONE BY a<
•
The following is ready for In;=p cti on:
)ector's Report: -
• • REQUESTED • ▪ WILL BE READY
•
•
•
•
•
•
•
•
•
• • i •
• •
•
• •
•
•
• •
Owner's Name and Address _
Registered Architect and /or Engineer _ _
Employing Plumber's Name
Location and Legal Description Lot
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ Date__
' ;_ 72
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.
4 4-
Street and Number where work is to be performed —No __
State work to be performed and purpose of building (By Floors) _
No._> 1 /TIC ' Street_ __V _ __412
g Block_ Subdivision
!
Street 6
New Building Remodeling Addition Repairs
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $_
ss.
My Commission Expires
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA;
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
(Signed)
•
No. �® ! Street/
Notary Public. State of Florida
No. of Stories
Plumbing Inspector.
rtify that lfe understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, o work to be performed uncle; ttI'lis permit, 7 s i are
?
'�54es!
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
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
Owner's Name and Address _
Registered Architect and /or Engineer _ _
Employing Plumber's Name
Location and Legal Description Lot
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ Date__
' ;_ 72
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.
4 4-
Street and Number where work is to be performed —No __
State work to be performed and purpose of building (By Floors) _
No._> 1 /TIC ' Street_ __V _ __412
g Block_ Subdivision
!
Street 6
New Building Remodeling Addition Repairs
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $_
ss.
My Commission Expires
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA;
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
(Signed)
•
No. �® ! Street/
Notary Public. State of Florida
No. of Stories
Plumbing Inspector.
rtify that lfe understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, o work to be performed uncle; ttI'lis permit, 7 s i are
?
'�54es!
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.
1
Permit
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
A@PLICATION FOR PLUMBING PERMIT
Date___
—c /c)
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 11,tr
Registered Architect and /or Engineer
^
Employing Plumber's Name ^t
State work to be performed and purpose of building (By Floors)
?• No.
Street and Number where work is to be performed —No IV
Nature of Water Supply: City —Well.
Amount of Permit $ t (Signed)
(Signed)
No Street
"
Street t
Location and Legal Description Lot_ + -3f_ _7s _ __ � Block Subdivision.LL! '
Street f f '`'
_ ,,...cur ✓... - _, -C-..
r
New Building Remodeling Addition ' Repairs No. of Stories
Capacity Gals.
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, k
ss.
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
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
F RES
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
1
Permit
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
A@PLICATION FOR PLUMBING PERMIT
Date___
—c /c)
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 11,tr
Registered Architect and /or Engineer
^
Employing Plumber's Name ^t
State work to be performed and purpose of building (By Floors)
?• No.
Street and Number where work is to be performed —No IV
Nature of Water Supply: City —Well.
Amount of Permit $ t (Signed)
(Signed)
No Street
"
Street t
Location and Legal Description Lot_ + -3f_ _7s _ __ � Block Subdivision.LL! '
Street f f '`'
_ ,,...cur ✓... - _, -C-..
r
New Building Remodeling Addition ' Repairs No. of Stories
Capacity Gals.
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, k
ss.
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
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.
# 3'. S/ 'u -tit. 3 3
2 7 0 r !00 4 t
Permit No..__.,_
Owner's Name and Address
Employing Plumber's Name ___1X1- _` -hA !C _ 4 fly' n
Location and Legal Description Lod/Vial-
Street and Number where work is to be performed —No
MIAMI SHORES .VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Registered Architect and /or Engineer
No
State work to be performed and purpose of building (By Floors) t�Y1i
New Building Remodeling Addition
Size Septic Tank Type of Tank _____ Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit.
Nature of Water Supply: City —Well.
Amount of Permit $_
ss.
My Commission Expires
Date__ __,/
No Street
,/
.24 E° Street 6
Block Subdivision.. �2 t_,.______?a
Street a
Repairs No. of Stories
2 /?! / /
(Signed) _ . l
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) — i ! %nom e �
Notary Public. State of Florida
l Mast Plumber.
� ip1/1v
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 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
FI RES
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..__.,_
Owner's Name and Address
Employing Plumber's Name ___1X1- _` -hA !C _ 4 fly' n
Location and Legal Description Lod/Vial-
Street and Number where work is to be performed —No
MIAMI SHORES .VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Registered Architect and /or Engineer
No
State work to be performed and purpose of building (By Floors) t�Y1i
New Building Remodeling Addition
Size Septic Tank Type of Tank _____ Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit.
Nature of Water Supply: City —Well.
Amount of Permit $_
ss.
My Commission Expires
Date__ __,/
No Street
,/
.24 E° Street 6
Block Subdivision.. �2 t_,.______?a
Street a
Repairs No. of Stories
2 /?! / /
(Signed) _ . l
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) — i ! %nom e �
Notary Public. State of Florida
l Mast Plumber.
� ip1/1v
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 inspection, or faulty
materials and /or workmanship.