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70 NE 100 St (3)Permit No. . 7 3 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept ai building during progress of work. Owners Name and Address Valli • RAI NE S N N.E. 100 St:eet._ Registered Architect and /or Engineer____. Employing Plumber's Name LASSETER PLUMBING CORP. No.__ _ S treet_ - E • 13 Ave Location and Legal Description Lot..___._.----- _-- _ -__ -_ Block _ ___ . _--- _---- _-- ._..____ -- Subdivision Street and Number where work is to be performed —No 7(2. State work to be performed and purpose of building (By Floors)... New Building____ Remodeling X 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 $_ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition_ __X -- (Signed) _ (Signed) Strut N. E. 100 St. Repairs Date-- - - - ... Feb... 6.t. 1956 . No. of Stories bing nspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent upplement, 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 undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as an licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, i u, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 lac 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 foul materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS p � IJ �/ ,,� TOTAL FIKTUREI -- CONTR. LIST -V. 1 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•O POOL CONTR. LIST CHICK Permit No. . 7 3 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept ai building during progress of work. Owners Name and Address Valli • RAI NE S N N.E. 100 St:eet._ Registered Architect and /or Engineer____. Employing Plumber's Name LASSETER PLUMBING CORP. No.__ _ S treet_ - E • 13 Ave Location and Legal Description Lot..___._.----- _-- _ -__ -_ Block _ ___ . _--- _---- _-- ._..____ -- Subdivision Street and Number where work is to be performed —No 7(2. State work to be performed and purpose of building (By Floors)... New Building____ Remodeling X 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 $_ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition_ __X -- (Signed) _ (Signed) Strut N. E. 100 St. Repairs Date-- - - - ... Feb... 6.t. 1956 . No. of Stories bing nspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent upplement, 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 undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as an licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, i u, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 lac 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 foul materials and /or workmanship. ' MIAMI SHORES VILLAGE Permit No Amount of Permit $___ D A, SS. Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description 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 th6 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, whethererein specified or not. A copy of approved plans and specifications must be kept at building during progress of wo : / f a Owner's Name and Address / . ' '�� t , No gj I f 4 __ �✓ l No. Street hlloc k____ Subdivision 1 - __,_.,,.,, Street and Number where work is to be performed —No. J1 1 1 Street / 0" d .l /., o f 76 Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit (Signed) Date 115 4fr Street L State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Capacity Gals 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- _d with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be rormed 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 -ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are by Miami Shores Village. a `- r C , - -, .. i (Signed) - -4- ar - .� C- �_� -- fit „ � . : Master Plumber. I a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared '—vorn, upon oath deposes and says that he is the `ully read the foregoing application, and that he did sign the same, and that all facts Notary Public, State of Florida �z is made necessary by improper notice for inspection, or faulty CLOSETS BATH TUBS SHOWERS LAVA - TORIES SINKS SLOP SINKS LAUNDRY TUBE: URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK EWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM POOL CONTR. LIST CHECK ' MIAMI SHORES VILLAGE Permit No Amount of Permit $___ D A, SS. Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description 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 th6 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, whethererein specified or not. A copy of approved plans and specifications must be kept at building during progress of wo : / f a Owner's Name and Address / . ' '�� t , No gj I f 4 __ �✓ l No. Street hlloc k____ Subdivision 1 - __,_.,,.,, Street and Number where work is to be performed —No. J1 1 1 Street / 0" d .l /., o f 76 Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit (Signed) Date 115 4fr Street L State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Capacity Gals 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- _d with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be rormed 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 -ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are by Miami Shores Village. a `- r C , - -, .. i (Signed) - -4- ar - .� C- �_� -- fit „ � . : Master Plumber. I a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared '—vorn, upon oath deposes and says that he is the `ully read the foregoing application, and that he did sign the same, and that all facts Notary Public, State of Florida �z is made necessary by improper notice for inspection, or faulty CLOSETS SEPTIC TANK BATH TUBS SEWER CONN'. SHOWERS DRAIN FIELD SOAKAGE PIT SLOP SINKS GREASE TRAP SOLAR HEATER CONTR. LIST CHECK CONTR. LIST CHECK 1 Permit No..__. ( ✓ y Application is hereby made for the approval of the detailed statement o structure herein described. This application is made in compliance and co and all provisions of the Laws of the State of Florida, all ordinances of M of Miami Shores Village shall be complied with, whether herein specifi building during progress of work. Qwn.er's...Name -.and Address _ IL t Registered Architect and /or Engineer ____________. s} Employing Plumber's Name Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. i ss. Before me, the undersigned appeared __ MIAMI SHO PLUMBING INSPEC APPLICATION FOR My Commission Expires e • . r Location and Legal Description Lot_ _ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Additi to me well known, and who, being by me first duly sworn, upon oath of the above described construction, that he has carefully read the therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such materials and /or workmanship. DE WE Size Septic Tank__ Type of Tank Feet of Drain Tile__________________________ Dist. Feet of Tank or Draini Nature of Water Supply: City —Well. .Si The undersigned applicant for this building permit does hereby certify under the Florida Workmen's Compensation Act, being Section 5966, Co plied with the provisions thereof, and will require similar compliance froi 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. authority, a notary public, duly authi i ES VILLAGE ION DEPARTMENT PLUMBING PERMIT the plans and specifications herewith submitted for the building or other formity with the Building Ordinance of Miami Shores Village, Florida. ami Shores Village and all rules and regulations of the Building Division d or re-inst not. No. ___ i t_1_ ✓____ Street_ 41e- 2 No._ —'f --- •{ — Street_, lock__ A RY S P L URINALS SPRKLR. SYSTEM ;contractors, on ned) A copy of approved plans and specifications must be kept at / CATCH BASIN work i LAUN ,n Repairs- ____ No of Stories______. Tu Field from Well___ e of Soakage Pit .__ ! - Str eet__ - FLOOR DRAIN SWIM'G POOL ir _Capacity Gals._ ^____ __,_ Pluthbing Inspector. that he u4tderstands and accepts his obligations as an employer of labor ins piled General Laws of Florida Permanent Supplement, and has com- sub t all contractors or sub - contractors employed by him in the work to be section on the site of the work such public notice or notices as are to be performed under this permit, as are e Subdivision_ y DRINKING FOUNT'NS -- coined to administer oaths and take acknowledgments, personally depo e for kes and says that he is the. ;oing application, and that he did sign the same, and that all facts t A i J aection is made necessary by improper notice for inspection, or fau!%y • .) .„, I qp ,, ' w 4 it ". I * Notary Public. State of Florida Master Plumber. .uJ / 1P _ L , a TOTAL FIXTURES BUILDING ELECTRICAL PLUMBING The following is ready for Inspection: Inspector's Report : • • AD: >0' /2 WORK DONE BY: • • :R EQUESTE D • WILL BE READY Permit No. .._2__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date___ 1 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 _ ___ ° — No.__,.. ../_____ �_- s Registered Architect and /or Engine Employing Plumber's Name ., y � _____ Location and Legal Description Lot__ 1 _ ____ 1' Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building_ Amount of Permit My Commission Expires ___________ _ Type of Tank 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. .Block_ Remodeling Addition n � f Street_ s _ ' �_��. 4. Subdivision__ V/ Street__ Repairs Size Septic Tank_______ Feet of Drain Tile___________ Nature of Water Supply: City —Well. Size of Soakage Pit. (Signed) ___ (Signed) _Capacity Gals Notary Public. State of Florida No. of Stories „! Dist. Feet of Tank or Drain Field from . er Plumbing Inspector. rtify that he u erstands 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, on work to be performed under this permit, as are 'f r Master Plumber. •1• STATE OF FLORIDA, 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. 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. i. 7 CHECK , SEPTIC TANK SEWS CON . DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G P001. CONTR. LIST CHECK Permit No. .._2__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date___ 1 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 _ ___ ° — No.__,.. ../_____ �_- s Registered Architect and /or Engine Employing Plumber's Name ., y � _____ Location and Legal Description Lot__ 1 _ ____ 1' Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building_ Amount of Permit My Commission Expires ___________ _ Type of Tank 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. .Block_ Remodeling Addition n � f Street_ s _ ' �_��. 4. Subdivision__ V/ Street__ Repairs Size Septic Tank_______ Feet of Drain Tile___________ Nature of Water Supply: City —Well. Size of Soakage Pit. (Signed) ___ (Signed) _Capacity Gals Notary Public. State of Florida No. of Stories „! Dist. Feet of Tank or Drain Field from . er Plumbing Inspector. rtify that he u erstands 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, on work to be performed under this permit, as are 'f r Master Plumber. •1• STATE OF FLORIDA, 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. 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. 4 Village of Miami Shores N° 3922 JOB 7' e .s e _ -�,� ADDRESS INSPECTION A) id & TIME READY / 7 3 REMARKS 61_ A PC- 0 ie,■ C INSPECTOR DATE X' '11(° J 'Village of Miami Shores JOB p tom • ADDRESS A ' /e3 e REMARKS J/V `ate INSPECTOR N° 3669 INSPECTION Po. tg . ?/' (' , TIME READY / DATE 4 o BUILDING ELECTRICAL PLUMBING PERMIT Work to be performed Owner of Building i ; Legal Lot !r too Bl. Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE N9 2616 Architect Contractor or Builder .+ under this Permit Subdi- vision Value of Project — 194 Contractor's License No By Amt. of ! Permit f "' • -; • 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. t 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 regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. AUTHORITY Permit No. .___f! F..r� APPLICATION FOR PLUMBING PERMIT STATE OF FLORIDA, L COUNTY OF DADE. ss. Amount of Permit $- --- - -- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildin or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vill. e, 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 Buil• ng Division of Miami Shores Village shall be complied wit whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of ork. Owner's Name and Address ' ` No 3 4 Street Registered Architect and /or Engineer Employing Plumber's Name __ , " t '" No Street Location and Legal Description Lot__ JE • / . /� Block_ Subdivision__ Street and Number where work is to be performed No._ _ (�' 40' E� ':• Street____ State work to be performed and purpose of building (By Floors) _ New Building Ate!! `_______________ Remodeling Addition Repairs No. of Stories Size Septic Tank__ 42 Type of Tank tilt" 1 . ' _ Capacity Gals._ SY d _ Feet of Drain Tile_____ _ ____ �___________ Dist. Feet of Tank or Drain Field from Well__ Nature of Water Supply: City-de/nil _ Size of Soakage Pit __________________________ _________ _________________�_�__ (Signed) Date_ The undersigned applicant for this building permit does hereby certify tha'f'e 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. , �s C . 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. Notary Public, State of Florida • Plumbing Inspector. Master Plumber. 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 Permit No. .___f! F..r� APPLICATION FOR PLUMBING PERMIT STATE OF FLORIDA, L COUNTY OF DADE. ss. Amount of Permit $- --- - -- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildin or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vill. e, 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 Buil• ng Division of Miami Shores Village shall be complied wit whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of ork. Owner's Name and Address ' ` No 3 4 Street Registered Architect and /or Engineer Employing Plumber's Name __ , " t '" No Street Location and Legal Description Lot__ JE • / . /� Block_ Subdivision__ Street and Number where work is to be performed No._ _ (�' 40' E� ':• Street____ State work to be performed and purpose of building (By Floors) _ New Building Ate!! `_______________ Remodeling Addition Repairs No. of Stories Size Septic Tank__ 42 Type of Tank tilt" 1 . ' _ Capacity Gals._ SY d _ Feet of Drain Tile_____ _ ____ �___________ Dist. Feet of Tank or Drain Field from Well__ Nature of Water Supply: City-de/nil _ Size of Soakage Pit __________________________ _________ _________________�_�__ (Signed) Date_ The undersigned applicant for this building permit does hereby certify tha'f'e 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. , �s C . 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. Notary Public, State of Florida • Plumbing Inspector. Master Plumber. 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.