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379 NE 100 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address 1 0) ( Ieo •` › l Tax Folio // ,V/4 // 637 0 Legal Description 4 f # 9-7 .9 6 i / Owner / Lessee / Tenant (5A`00 Master Permit d CO Owner's Address .-2 --; 7 ck V■3 4. I t' « ;1 Phone 75 Q • / 5 0 Contracting Co. -(2..6 \Z.doAt Address ()022 SW - -?>:1 C 7 (f1 X41- 4- 01,-u: 3' z; Qualifier \C c \L VA1 pr' SS# . Phone C I (7(F f l- '(1 c State 1i Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. - ZOO y" Estimated Cost(value) l cSt ) 0 '> 1 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: APPROVED: Zoning Buildin Signatur Date: f Contractor or Fire Other bk-k-ukgA rc Notary ontractor or Owner- Builder My Commission Expires: DAVID MILGk. M ** * * * * * * * * * * Of:0 MY co v1.4 EXP. 3.117-96 ** tt • PUBLIC q BON BY SER INS CCU SO NOTAR °F ` NO TOTAL DUE cO kes FEES: PERMIT�d ' �7/ // RADON C.C.F. Electrical Mechanical Plumbin_� /yl engineering CONSTRUCTION PERMIT FOR: [ j ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [...kJ Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: - AGENT: PROPERTY STREET ADDRESS: LOT: BLOCK: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS T [ t A [ N [ K [ 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC SUBDIVISION: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ °] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED I CONFIGURATION: [ ] TRENCH [,] BED N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 - 0) [ ] MOUND [ ] [ ] 4 INSTALLER /CONTRACTOR PERMIT # ` DATE PAID FEE PAID $ RECEIPT # EXPIRATION DATE: ,, y CPHU Page 1 of 2 INSIRU( PE:RM11rr NUMBLR: Permit tracking number assigned by CP11U. APPLI('A1 lt )N FOR: fr,_k tope nl permit, if "l)th, i specify type in blank. APPLICANT Pnq)erty owner's lull name. TE.LEPIie )NE Tclephtrnc nuniker for applicant or agent. AGENT 1'ropert■ ounce's legally authorized representative. MAILING ADDRESS. P.O. I an or street mailing address In applicant or agent. LOT, BLOCK. SUBDIVISION or PROPERTY IOW: 27 chu:)t.tce id nun i14:1 ter properly. (CPllll may req.)ire property appraiser 1D Nor section /township /range /parcel nunther) SYSTEM DESIGN AND SPECIFICATIONS: TANK: M1liminnun speeiticaliotts from Chapter IOD -6, FAC. DRAINFIFLD: Minimum specifications from Chapter IOD 6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must he sealed. APPROVED BY County Public Health Unit (C1'11U) personnel reviewing and approving permit. DATE. ISSUED: Date permit is issued by CP11E1. EXPIRATION DATE: One year from date issued if the system has not been installed. Penults for system repairs become void 90 days from the date issued. Site Plan Submitted by . STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM :Pe! Applic Number P A R T I I SITE FiLAN ' I 1 111 ; 1 1 , I I 1 1 I I 1 1 I 1 1_ _I 1 1,..1 ' 1 I 1 ' I ; ' I I . I 1 111 ' ' ; 1 ; - III 111 1 1 11 1 1 II . 1 ''...i 1 1 I I 1 1 •"' 11 . I I t 1 1 1 11 I 1 1 ' 11 '. I 1 I 1 ' : 1 ' 1 1 1 1 1 1 1 1 '1 I 1 I 1 : 1 11 il l I • . ! 1 1 1 1.,..1 1 i 1'1 I 1 11 ' 11 I r7 1 --- 1 1 ., , . 1 1 ' I 1 ' ■ I 1 1 11 . .. , 1 ' r I 1 1 1 1 11, 1 Z t,.... . _ , 1 , . ' ■ I 1 , . I , , , ., 1 1 , ' Notes 1 c if it. )e. / () SIGNATURE Plan Approved Not Aproved By -44 ALL CHANGES MUST BE APPROVED BtiHE, HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744-002-4015-6) a a ■ . , 1 I 1 1 • 1 I 1, . I I 1 I i I 1 1L - 1 1 _ r ;I-: 1 , 1 1 )1 4 _,.... 4 ., 1 1 , , ; I 1 4,.„„....,,.. . ; _ ; 4.;,,, , ,.. 4 .1.... ... 1. _„.; r ....,..1...4 , -...4.-4-4,, , , , ...0-47.----.....4-4....4,-. 4.,- 1 + , * ...-r. . I i f I i 1 - I ; , ' i ; 1 i ; 1 , ' , i, . i 1 ; ,1 ; ; 1 I. I I 1 1 ; 1 1 i . 1 1 1 1 ' I I ; I ,i 1 ' I i • CI 1 i 1 TITLE Date — % County Public Unit Page 2 of 3 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING C'"t Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith ubmitted or the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinan a 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 Addr Amount of Permit $ 7 Registered Architect . /or Engineer 7- Employing Plune ey l -- Location and Legal escription Lot.. _.._--- __ _______�________ My Commission Expires 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_ Feet of Drain Tile_____------- .------ •--- •--------- - - - - -_ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: — __._Size of Soakage Pit l — — — (Signed) - - L (Signed)._ Capacity Gals. Streety.°_L ... Notary Public, State of Florida No. of Stories. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati • .s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus 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. Master Plumber. 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 hint 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 SHOW [RS LAVA TORIES SINKS SLOP SINKS LAUNDRY Tues URINALS CATCH BASIN FLOOR DRAIN DRINKI NO FOUNT•NB TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL CONTR. LIST CHECK -. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING C'"t Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith ubmitted or the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinan a 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 Addr Amount of Permit $ 7 Registered Architect . /or Engineer 7- Employing Plune ey l -- Location and Legal escription Lot.. _.._--- __ _______�________ My Commission Expires 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_ Feet of Drain Tile_____------- .------ •--- •--------- - - - - -_ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: — __._Size of Soakage Pit l — — — (Signed) - - L (Signed)._ Capacity Gals. Streety.°_L ... Notary Public, State of Florida No. of Stories. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati • .s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus 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. Master Plumber. 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 hint 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. BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ Owner of Building I! wt Architect Contractor or Builder Legal Description Address of Building T 12 Lot MIAMI SHORES VILLAGE. FLORIDA DATP. / , 195_4_ Contractor's License No. PERMIT N° 4192 c3 r 1 1 .4 f t— Work to be performed under this Permit B1 Subdi- vision L L. Value of Project $ '' Amount of Permit $ This permit is granted to the contractor or builder named above to construc 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 cr in the statements or sp cifications and that he assumes responsibility for work done by his agents, servants or employees. r r CONTRACTOR OR BUILDER Signed. (4) 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. BY AUTHORITY MIAMI SHORES VIL1AGE PLUMBING INSPECTION DEPARTME0.' APPLICATION FOR PLUMBING r. m.-I Permit No. /7/ �! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s bitted for the building or other structure herein described. This application is made in compliance and conforndty 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 rot. A copy of approved plans and specifications must be kept at building during progress of work. � Owner's Name and Address/7 Y__ �/ _!_ -------------- • -• - - -- No. Registered Architect and /or Engineer______ ________._ Employing Plumber's Name-_ Size Septic Tank My Commission Expires No._ Location and Legal Description Lot_ --_--._.'.__________ �� ,� Bllock -- Street and Number where work is to be performed —No _, Q ,2.Z -_4 £ / W 4 Street State work to be performed and purpose of building (By Floors) ____!Y -- te r New Building _ ___ Remodeling ___._____________.._____ Addition Repairs No. of Stories. 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 i Zt� t7 t_Y_ ! :1_i -C-P1 - �_.____J..- . s..��- °---- ( Signed) _.°! ._! L_! Date �_.17— -s' Street - (7 /XA/c Street _f _7 Subdivision — Notary Public, State of Florida Amount of Permit $ "2- -- (Signed)__!'`' !- 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 Iles 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 nder this permit, as are licensed by Miami Shores Village. Master Plumber. 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 S INKS SLOP SINKS LAUNDRY TUBS U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'O POOL CONTR. LIST /t r�SS� J r H. t fro ,,t a &L' n ,G ` _ CHECK MIAMI SHORES VIL1AGE PLUMBING INSPECTION DEPARTME0.' APPLICATION FOR PLUMBING r. m.-I Permit No. /7/ �! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s bitted for the building or other structure herein described. This application is made in compliance and conforndty 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 rot. A copy of approved plans and specifications must be kept at building during progress of work. � Owner's Name and Address/7 Y__ �/ _!_ -------------- • -• - - -- No. Registered Architect and /or Engineer______ ________._ Employing Plumber's Name-_ Size Septic Tank My Commission Expires No._ Location and Legal Description Lot_ --_--._.'.__________ �� ,� Bllock -- Street and Number where work is to be performed —No _, Q ,2.Z -_4 £ / W 4 Street State work to be performed and purpose of building (By Floors) ____!Y -- te r New Building _ ___ Remodeling ___._____________.._____ Addition Repairs No. of Stories. 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 i Zt� t7 t_Y_ ! :1_i -C-P1 - �_.____J..- . s..��- °---- ( Signed) _.°! ._! L_! Date �_.17— -s' Street - (7 /XA/c Street _f _7 Subdivision — Notary Public, State of Florida Amount of Permit $ "2- -- (Signed)__!'`' !- 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 Iles 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 nder this permit, as are licensed by Miami Shores Village. Master Plumber. 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. Permit No. ._ j_ /l 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. I a Owner's Name and Address /Z t - � `'� No 3 ? Street Registered Architect and /or Eng' eer a Employing Plumber's Name„/ _ _ ._ = 4. Xe _Li s No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be perforrne rid purpose of building (By Floors) New Building Remodeling Addition Repairs__ Size Septic Tank ` U i�' Type of Tank t, e Feet of Drain Tile STATE OF FLORIDA, t COUNTY OF DADE. Amount of Permit $ Nature of Water Supply: City —Well. Size of Soakage Pit ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ' `E st. Feet of Tan1'or Drain Field from Well (Sig Date Capacity Gals._ Notary Public, State of Florida ar#.; No. of Stories 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 Permaneht 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 to of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors,/ work to Ite "lie +rmed under this permit, as are licensed by Miami Shores Village. im er. 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 FIXTURES CONTR. LIST CHECK SEPTIC TANK WER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST _ „r CHECK ° \ r� _ Permit No. ._ j_ /l 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. I a Owner's Name and Address /Z t - � `'� No 3 ? Street Registered Architect and /or Eng' eer a Employing Plumber's Name„/ _ _ ._ = 4. Xe _Li s No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be perforrne rid purpose of building (By Floors) New Building Remodeling Addition Repairs__ Size Septic Tank ` U i�' Type of Tank t, e Feet of Drain Tile STATE OF FLORIDA, t COUNTY OF DADE. Amount of Permit $ Nature of Water Supply: City —Well. Size of Soakage Pit ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ' `E st. Feet of Tan1'or Drain Field from Well (Sig Date Capacity Gals._ Notary Public, State of Florida ar#.; No. of Stories 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 Permaneht 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 to of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors,/ work to Ite "lie +rmed under this permit, as are licensed by Miami Shores Village. im er. 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.