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1490 NE 101 St (6)Permit No.____ a.. Owner's Name and Address Registered Architect and /or Engipger___ Employing Plumber's Name ' _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 61,4a Date 7J �� Street_ 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 wor No.__ ----- _--------- --- _ -__ -- Street. Location and Legal Description ..... Block_ _ _ ____ Subdivision . -- _-- •--------- .- _----- -_ -_ -� 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 No. of Stories Capacity Gals Size Septic Tank _____ Feet of Drain Tile________.o?__ —_= s ea o ank or Drain Field from Well Nature of Water Supply: City — Well.__________________ _________ ..... ____________.Size of Soakage Pit Amount of Permit $ 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 Ilas 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 perfolmed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. y Commission Expires (Signed)- (Signed)___ Notary Public, State of Florida aster Plumber. 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. A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty ma : . , • /or worllmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES INK SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NB 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 - -- O Permit No.____ a.. Owner's Name and Address Registered Architect and /or Engipger___ Employing Plumber's Name ' _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 61,4a Date 7J �� Street_ 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 wor No.__ ----- _--------- --- _ -__ -- Street. Location and Legal Description ..... Block_ _ _ ____ Subdivision . -- _-- •--------- .- _----- -_ -_ -� 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 No. of Stories Capacity Gals Size Septic Tank _____ Feet of Drain Tile________.o?__ —_= s ea o ank or Drain Field from Well Nature of Water Supply: City — Well.__________________ _________ ..... ____________.Size of Soakage Pit Amount of Permit $ 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 Ilas 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 perfolmed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. y Commission Expires (Signed)- (Signed)___ Notary Public, State of Florida aster Plumber. 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. A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty ma : . , • /or worllmanship.