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PLUMBING PERMITState # Architect/Engineer Bonding Company Mortgagor !Lf % 33 D C7 FEES: PERMIT - RADON riuAn0 d 2g 7 /0 /sfi. Municipal # PERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e / ^ Z 7 - I Job Address 87 /v, / f Tax Folio Legal Description Owner/Lessee / Tenant Owner's Address Contracting Co. l.. /p lk 12 P1v-cliti) 10 S l[JM 1? I N er GA2� Qualifier d s 1, Permit Type (circle one): BUILDING ELECTRICA PLUMBIN 1» ORK DESCRIPTION 'i �J /1 / ° o 7 ( #ts # VIN 2 fro Square Ft. g / Historically Designated: Yes Address Master Permit # SS# ,? 71Phone Competency # /,6 0 �S 0 Address / Address /V Address N/ Phone / /x y Ins. Co. MECHANICAL OOFING PAVING FENCE SIGN tti Estimated Cost (value) .2 i yoz 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 Co : 'resident Date Signature of Contractor or Owner- Builder Notary as to Contractor or Owner- Builder Notary as t. • wner and/or Condo President Date My Co ssion Expires: My Commission Expires: NOTARY No 3,8 SJcoTJs d IC /0. Date Date TOTAL DUE APPROVED: Zoning Building / Electrical Mechanical Plumbing / a Engineering Permit No. Employing Plumber's Name Size Septic Tank ISO Feet of Draine Nature of Water Supply: City - Well 900 1 / S fr• OFFICIAL NOTARY SEAL VELDA HORTON NOTARY PUBLIC STATE OF FLORIDA 436225 M COMMISSION IDC P FEB. 9,1999 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of lank /,o78e!" a /e Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Si e' Capacity Gals. SS. Date / 0 f b 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 the progress of work. Owner's Name and Address E 1 ` No. 1 N'. Street /D/ s 7 Registered Architect and/or Engineer No. / 0 J W Street 31t" ST - Location and Legal Description Lot / Q A' E / / ft Block Subdivision Z Street and Number where work is to be performed — No. v 7 /0/ . Street I State work to be performed and purpose of building (By Floors) /NC14 /f /,on PI fa 7 / XI hi h t /5 ffir. P/ /$.1P/ 4 „chip AA New Building Remodeling Addition Repairs No. of Stories 11. / ?oa Amount of Permit $ (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 has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the w.rk 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 _,r:' 'by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Mia =00 age. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersi ned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared �'�iz -cam 4 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. Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNTAINS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G. POOL CONTR. LIST t ' CHECK i 1 Permit No. Employing Plumber's Name Size Septic Tank ISO Feet of Draine Nature of Water Supply: City - Well 900 1 / S fr• OFFICIAL NOTARY SEAL VELDA HORTON NOTARY PUBLIC STATE OF FLORIDA 436225 M COMMISSION IDC P FEB. 9,1999 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of lank /,o78e!" a /e Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Si e' Capacity Gals. SS. Date / 0 f b Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during the progress of work. Owner's Name and Address E 1 ` No. 1 N'. Street /D/ s 7 Registered Architect and/or Engineer No. / 0 J W Street 31t" ST - Location and Legal Description Lot / Q A' E / / ft Block Subdivision Z Street and Number where work is to be performed — No. v 7 /0/ . Street I State work to be performed and purpose of building (By Floors) /NC14 /f /,on PI fa 7 / XI hi h t /5 ffir. P/ /$.1P/ 4 „chip AA New Building Remodeling Addition Repairs No. of Stories 11. / ?oa Amount of Permit $ (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 has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the w.rk 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 _,r:' 'by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Mia =00 age. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersi ned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared �'�iz -cam 4 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. Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship.