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361 NE 101 St (5)BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATF /1 -f „T 195 ERMIT IT? 12408 n Work to be performed under this Permit Architect Contractor or Builder ;' LI:a) ,, t ,... Legal Lot g I1 31. Le Description Address of Building L. `) - 1 1, i Subdi- vision Value of Project $ BY Contractor's License No Amt. of Permit $ 477 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 Ate. 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. Signed- BY INSPECTOR In consideration of the issuance to me of this permit I agree to rm the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statem nts 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. L 1 / 6 ? Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Flor. 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 Divisio.. 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 L `V Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) r Date._ No Street New Building Remodeling Addition Repairs No. of Stories 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 Registered Architect and /or Engineer Employing Plumbei's Name _ :. ( l �' No Street__ Location and Legal Description Lot Block Subdivision / Street and Number where work is to be performed—No _1g_-(- ____ Street 4____ / j State work to be performed and purpose of building (By Floors) ``"I 1 __,.. - i:.,s_ Lam. fl • s:- A ( Signed) My Commission Expires Notary Public, State of Florida 1 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- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the wdrk to be performed under this pennit; 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. 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 SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK ' - Permit No. L 1 / 6 ? Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Flor. 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 Divisio.. 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 L `V Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) r Date._ No Street New Building Remodeling Addition Repairs No. of Stories 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 Registered Architect and /or Engineer Employing Plumbei's Name _ :. ( l �' No Street__ Location and Legal Description Lot Block Subdivision / Street and Number where work is to be performed—No _1g_-(- ____ Street 4____ / j State work to be performed and purpose of building (By Floors) ``"I 1 __,.. - i:.,s_ Lam. fl • s:- A ( Signed) My Commission Expires Notary Public, State of Florida 1 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- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the wdrk to be performed under this pennit; 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. 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. i BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 3673 Work to be performed under this Permit Bl. Subdi- vision Value of Project DATE Contractor's License No -. (.tt`rttsa n X 13' - . Amt. of Permit BY AUTHORITY 1 94; 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. Signed• By 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 aurlpgties of MiamilliOres Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BUILDING ELECTRICAL PLUMBING Architect Contractor or Builder Legal Description Address of Building Lot r MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 3676 Work to be performed under this Permit r ` Owner of , • Building ' s" c s . <° • T Bl. Subdi- vision Value of Project p3riilit. DATE Contractor's License No. Wt Pr !!C: Th.. , rrrst * !T Ty bs in Teel �f P _ Amt. of / Permit 4 ..ad :.u:?: iiutt:Ciiit"du ii 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. Signed• - By 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 Shore; Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 194 BUILDING ELECTRICAL PLUMBING Owner of Building PERMIT N? 3580 Work to be performed under this Permit y C4144011E4 to consult your War Picr_iuetion this met Board office before starting we work authoriz to Architect Contractor L, or Builder 1 % Legal Lot a'"' rj y 2 i Description Address of -°r a " , Building .3 '` f # } ' MIAMI SHORES VILLAGE, FLORIDA DATE i;' .. ! „� °� J � - 1 4 • t Bl. Subdi- vision Value of Project Contractor's License No Amt. of Permit I 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. r Signed• i By f f ,, INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covetred 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 redone ` f spon,sibility for all work donne either myself, my agent, servant or employee. g� R . ..V; „'' i f . a� .. >- - _..i'' ,f J o CONTRACTOR OR BUILDER 1 BY AUTHORITY 194 -- - CITY PLUMBING COMPANY .11A-c-14_ cd0B SHEET IAMI, FLORIDA Journeyman Plumber Job No. PLUMBING FIXTURES and DIAGRAM OF LAY For a / story Owner Contractor Lot.2.0 .24 Block .38' Sub-Divison ( .,4112/.• Street No. W - C Number of fixtures shown on plan of proposed plumbing Ce 7 0"1"-- t 19 i•/:2 04 )1- 14, /7 C2-"t °4:414-*- h T U 4 SHOWER 4 --- r ;• ' 44= . 1' if/ LAV. SINK / 1......c/?1 (4 .0,1 .."/ e "(;) t t LAUN. TRAYS c_ • From To 1,„ ft% N R.L.Saxon 361 N.E. 101 St., Miami Shores Village CITY PLUMBING CO. INTER OFFICE MEMO Lis Date ^ r • BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description '` _ r Bl. PERMIT N° 3580 V\ ,Work to be performed under this Permit 4-.' ; MIAMI SHORES VILLAGE, FLORIDA DATE `, ' )' 1941_ Subdi- vision Contractor's License No. WARR This CoMfmfhe am IN M wistaria et MN Production Noun/ Cameral Limitations Order [41 vp41 art caa6004 to roost:It yc +)r Wm. P, macs** Board office Whore sisrtinI the work authorized in Ns omit Address of Value of Amt. of t f Building 3 1 I ° 4 11 `s Pro ject �, '> Permit f i 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. Signed- i .%''' By , INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covet'e'd hereunder in compliance with 11 ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper, thorities of Miami Shores Village. In accepting this permit I assume responsibility for all work do by either myself, my agent, servant or employee. i ■ i 1 CONTRACTOR OR BUILDER BY AUTHORITY J BUILDING ELECTRICAL PLUMBING Owner of Building Contractor or Builder Legal Description 4' MIAMI SHORES VILLAGE, FLORIDA DATE `� PERMIT N9 • 4015 Work to be performed under this • 1 Architect B.. Perini Subdi- vision Contractor's License No. 7 194 Address of (- Value of Amt. of �. Building c-?; Project Permit This permit is granted to the co trac or ofbuilder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w'th the understanding that the work will be performed in compliance with any i 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 statemeAs or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. t l.. ; Signed • L.,, ' 14 N4 - t. By :r" l r 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 wii the lans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting thi�..permit I assu . responsibility for a ork done by either myself, my agent, servant or employee. ce . (TTRACT BUILDER ♦ BY AUTHORITY I APPLICATION FOR PLUMBING PERMIT 2 Permit No �? Date_ ______. ___ _- -_ 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. k.. l Owner's Name and Address 1./_44 --_ No l _4(f1JfL ftreet Registered Architect and /or En ineer Employing Plumber's Name _4.2 1.0. Ci e Location and Legal Desc Lion Lot_ _ ,,1/, i_)_______�_____________Block__ 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 - _1;2____________- _____ .__ Type of Tank . _Capacity Gals _t_ —___ -- / r Feet of Drain Tile____ �___- ______ —_ _ Dist. Feet of Tank or Drain Field from Well__3 � Nature of Water Supply: City — Well._ - _r. ✓ ,�,,t Size of Soakage Pit Amount of Permit $_ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT _(Signed) (Signed) 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 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. 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 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 H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK I APPLICATION FOR PLUMBING PERMIT 2 Permit No �? Date_ ______. ___ _- -_ 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. k.. l Owner's Name and Address 1./_44 --_ No l _4(f1JfL ftreet Registered Architect and /or En ineer Employing Plumber's Name _4.2 1.0. Ci e Location and Legal Desc Lion Lot_ _ ,,1/, i_)_______�_____________Block__ 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 - _1;2____________- _____ .__ Type of Tank . _Capacity Gals _t_ —___ -- / r Feet of Drain Tile____ �___- ______ —_ _ Dist. Feet of Tank or Drain Field from Well__3 � Nature of Water Supply: City — Well._ - _r. ✓ ,�,,t Size of Soakage Pit Amount of Permit $_ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT _(Signed) (Signed) 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 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. 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. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No.._r JC 1 Date 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 Registered Architect and /or Engineer Employing Plumber's Name — No Street No Street Location and Legal Description Lot__ _Block_ — _____ Subdivision_ Street and Number where work is to be performed—No. ' �___,: �__________�_________ Street State work to be performed and purpose of building (By Floors) New Building ________— _______________ Remodeling Addition _ Repairs Size Septic Tank —__ —_ /-1- • _ 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 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 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. STATE OF FLORIDA, COUNTY OF DADE. (Signed) _-_ (Signed) No. of Stories_ _Capacity Gals.___________ —_ 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public. State of Florida 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 E UNT'NS TOTAL FIXTURES CONTR. LIST r + CHECK ,t /� SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SdLAR H ATER DEEP W SPRKLR. SYSTEM SWIM'O POOL CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No.._r JC 1 Date 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 Registered Architect and /or Engineer Employing Plumber's Name — No Street No Street Location and Legal Description Lot__ _Block_ — _____ Subdivision_ Street and Number where work is to be performed—No. ' �___,: �__________�_________ Street State work to be performed and purpose of building (By Floors) New Building ________— _______________ Remodeling Addition _ Repairs Size Septic Tank —__ —_ /-1- • _ 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 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 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. STATE OF FLORIDA, COUNTY OF DADE. (Signed) _-_ (Signed) No. of Stories_ _Capacity Gals.___________ —_ 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public. State of Florida 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.