1460 NE 101 St (12)BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE, FLORIDA
DATE ' � 19
o PERMIT N9 4202 Contractor's
o License No. ?'
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description II Bl
Subdi-
vision
Address of - Value of 11 Amount of
Building Project $ 11 Permit $ 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 employees.
Signed. 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.
CONTRACTOR OR BUILDER
BY AUTHORITY
ASSOT
C1-"Ire
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
p°_
�
_W
r �S
1`
TOTAL
FIXTURES
ale R
,� /�
1
7$
^-
�'(( JJ ','
�
CHICK � A Z 5
iso
i 5
�. -- �_-
5
— 7 .�
_ - -_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
ER
lip.
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
�Y 'D �7
• �
CONTR.
LIST
O
4°
5A
Pre re
.4.
; 6 D
`!
CHICK
-
Permit No
Application is hereby m for the approval of the detailed statement of the plans and specifications he th • bmitted or the building or o er
structure herein descri This application is made in compliance and conformity with the Building Ordinance of Miam 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 wor
Owners Name and Address_ - -- ______ _____ No-i_ _OA__.__ _____ Street
Registered Architect and /or Engine, ..
d
a�
Employing Plumber's Name n _ �.____� No. _L, _ f
Location and Legal Description Lot. ______ .____._ Block
Street and Number where work is to be performed—No 7b
T
State work to be performed and purpose of building (By Floors)_
ew Building. Remodeling —_ ___ Addition.
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well.
STATE OF FLORIDA, f
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
My Commission Expires
_Type of
The undersigned applicant for this building permit does
under the Florida Worlanen's Compensation Act, being Section 5
plied with the provisions thereof, and will require similar compliance from
performed under this permit; and will post or cause to be posted' for inspection on the
required by tlie Act. The undersigned agrees to employ only such sub- contractors
licensed by Miami Shores Village.
Street
_Dist. Feet of Tank or Drain Field from Well
15 5
j Ision , •
s ,p
Repairs No. of Stories
Capacity Gals
- Size of Soakage Pit
rstands and accepts his obligations an empl yer /f labor
Laws of Florida Permanent Supplement, dAiias com-
rs or sub - contractors employed by him in t e work to be
site of the work such public notice or notices as are
on work to be performed uz}der this permit, are
Master Plumbe
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 $$hove 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
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.