390 NE 101 St (11)LLT l n5n +
CHICK
4
Permit No c-F: °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 _ - -B 111_ — W ightm a n__._..._ No. 3_9D N . . 1(1. S4ter e_e t
Registered Architect and /or Engineer_____--- _ ____—___ — _ _ —__--- ----- -- -- -- -••--- -- ---- _- -__ --_
Employing Plumber's Name R os-e S pp-t4 C T 1. r n . 0 ._ 344 X31: -e a-h Street--•
Location and Legal Description Blork Subdivision
Street a n d Number where work is to be performed —No 390 N - E �n 1 S t T P A street
State work to be performed and purpose of building (By Floors) _ _------------------- _____ --
New Building -_ - - -_ ___ -- _ -- Remodeling— _---- - - - - -_ ____ -- Addition_ ___ -._ Repairs No. of Stories.
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
1 —PO & Abandon
Amount of Permit $ 4X�n $iQCL
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o•j!'ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plier 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.
(Signed).
Capacity Gals
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 insp , In, or faulty
materials and/or workmanship.
CLOSETS
BATH S
SHOWERS L
LAVA- S
SINKS S
SLOP L
LAUNDRY U
URINALS C
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
LIST
CHECK
SEPTIC SEWER D
DRAIN S
SOAKAGE G
GREASE S
SOLAR D
DEEP S
SPRKLR. S
SW IM•G
CONTR.
/10
4
Permit No c-F: °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 _ - -B 111_ — W ightm a n__._..._ No. 3_9D N . . 1(1. S4ter e_e t
Registered Architect and /or Engineer_____--- _ ____—___ — _ _ —__--- ----- -- -- -- -••--- -- ---- _- -__ --_
Employing Plumber's Name R os-e S pp-t4 C T 1. r n . 0 ._ 344 X31: -e a-h Street--•
Location and Legal Description Blork Subdivision
Street a n d Number where work is to be performed —No 390 N - E �n 1 S t T P A street
State work to be performed and purpose of building (By Floors) _ _------------------- _____ --
New Building -_ - - -_ ___ -- _ -- Remodeling— _---- - - - - -_ ____ -- Addition_ ___ -._ Repairs No. of Stories.
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
1 —PO & Abandon
Amount of Permit $ 4X�n $iQCL
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o•j!'ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plier 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.
(Signed).
Capacity Gals
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 insp , In, or faulty
materials and/or workmanship.
BUILDING p MIAMI SHORES VILLAGE, FLORIDA •"
ELECTRICAL ❑ Date Z _i— 19 �••
PLUMBING ❑ PERMIT N? 8794 C ontractor's
ROOFING ❑ Li cense No.
❑ Work to be performed under this Permit
Owner of
Building r •
Architect
Contractor
or Builder
Legal Lat
Description
Address of
Building
, if
4 •
1 Bl
P
y... 1'4
Subdi-
vision
Sq. Ft.
Value of II Amount of
Project $ 11 Permit $
t '
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 applica-
tion 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 assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the pl s or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employ/es.
/ /
Signed 41 I. tZ": } NSPECZQF) BY
In consideration of the issuance to me of this permit I a ree o perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dra statements or specifications submitted to the pioper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work one by either, myself, my agent, servant or employee.
CONTRACTOR or BUILD BY / j°41./g
t AUTHORITY
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su`b mitt =•for the buildin or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi mi 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, w ether h in 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 E
Employing Plumber's Name
Location and Legal Description Lot____ ________ —_____
Street and Number where work is to be performed —No __3-Y Street
State work to be performed and purpose of building (By Floors) ________
N 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/akage Pit
Nature of Water Supply: City —Well
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_____ No._. — _.
— Block Subdivision
(Signed) _
(Signed)
Date____
Ng. Street lei
No._ Street.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ent, and Ilas com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by im 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 p
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
t, as are
er Plumber.
STATE OF FLORIDA, �,
COUNTY OF DADE. j
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
S
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
INALS
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
-• .._
. _ �..
.-...
..
<a _, _
... ..
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su`b mitt =•for the buildin or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi mi 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, w ether h in 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 E
Employing Plumber's Name
Location and Legal Description Lot____ ________ —_____
Street and Number where work is to be performed —No __3-Y Street
State work to be performed and purpose of building (By Floors) ________
N 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/akage Pit
Nature of Water Supply: City —Well
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_____ No._. — _.
— Block Subdivision
(Signed) _
(Signed)
Date____
Ng. Street lei
No._ Street.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ent, and Ilas com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by im 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 p
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
t, as are
er Plumber.
STATE OF FLORIDA, �,
COUNTY OF DADE. j
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building L✓
Architect
Contractor
or Builder
Legal
Description
Address of
Building
r'
Lot
T ,V /r! '. ,
3 9*
MIAMI SHORES VILLAGE, FLORIDA t7
❑ DATE /'r 6 " 195 6 '
❑ PERMIT N? 3025 Contractor's
License No. Iva
❑ Work to be performed under this Permit
0
CONTRACTOR OR BUILDER
i a1
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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
•
Signed•""
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covdred 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.
? S
Value of
Project $
vision
Amount of
Permit $ 1•
c?'
AUTHORITY a„
Permit No - _ ___ - --
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foy"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. /J
Owner's Name and Address
Registered Architect and /or Engi
Employing Plumber's Name ._ - _• -Ol *�" -- -- - i / No.__2- .‘. __ -!Y__ meet___
Location and Legal Description Lot_•_-- _________ ___— .__"�_-� Block - Subdivision__._.__:
Street and Number where work is to be performed— No._ -22(P _ 7 i?.t'— .-� _- Street-__/ __Q
State work to be performed and purpose of building (By Floors)._
New Building Remodeling ___ Addition__
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
Amount of Permit $
r
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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami. Shores Village.
aa.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN
APPLICATION FOR PLUMBING " •;e,, MgT
_Type of Tank Capacity Gals
ea of Tank or Drain Field from Well
Size of Soakage Pit
( Signed)
(Signed).
Ott l J
No. No.- — ..3_,/ e ill - a eet. 1 '__
My Commission Expires Notary Public, State of Florida
Master Plumber.
Repairs No. of Stories
STATE OF FLORIDA, t
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 worlmanship.
CLO86TB
BATH
TUBS
SHOWER!
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
S
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 - _ ___ - --
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foy"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. /J
Owner's Name and Address
Registered Architect and /or Engi
Employing Plumber's Name ._ - _• -Ol *�" -- -- - i / No.__2- .‘. __ -!Y__ meet___
Location and Legal Description Lot_•_-- _________ ___— .__"�_-� Block - Subdivision__._.__:
Street and Number where work is to be performed— No._ -22(P _ 7 i?.t'— .-� _- Street-__/ __Q
State work to be performed and purpose of building (By Floors)._
New Building Remodeling ___ Addition__
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well
Amount of Permit $
r
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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami. Shores Village.
aa.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN
APPLICATION FOR PLUMBING " •;e,, MgT
_Type of Tank Capacity Gals
ea of Tank or Drain Field from Well
Size of Soakage Pit
( Signed)
(Signed).
Ott l J
No. No.- — ..3_,/ e ill - a eet. 1 '__
My Commission Expires Notary Public, State of Florida
Master Plumber.
Repairs No. of Stories
STATE OF FLORIDA, t
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 worlmanship.
Permit' No.
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
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street__a'
Employing Plumber's Name _7 '` �_ No Street_. .'</
Location and Legal Description Lot
__Block
Street and Number where work is to be performed—No � _________________ Street
State work to be erformed and purpose of building
P P P g (By Floors) -- r- ---- --= ---- -- ----- --- -=-
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank
—'
Feet of Drain Tile_ __Lf -__'� ` �.�___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .Size of Soakage Pit.
Type of Tank . Capacity Gals .........
_____ —_�_
Amount Of Permit $ (Signed)
The undersigne pplicant 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, 6n work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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.
r- My Commission Expires
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
tna ials and /or workmanship.
Date ______ __ _________
Notary Public, State of Florida
r
Plumbing Inspector.
Master Plumber.
CLOSETS
BATH
TU BS
SHOWERS
LAVA-
y 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
Ale
VP"
Permit' No.
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
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street__a'
Employing Plumber's Name _7 '` �_ No Street_. .'</
Location and Legal Description Lot
__Block
Street and Number where work is to be performed—No � _________________ Street
State work to be erformed and purpose of building
P P P g (By Floors) -- r- ---- --= ---- -- ----- --- -=-
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank
—'
Feet of Drain Tile_ __Lf -__'� ` �.�___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well .Size of Soakage Pit.
Type of Tank . Capacity Gals .........
_____ —_�_
Amount Of Permit $ (Signed)
The undersigne pplicant 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, 6n work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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.
r- My Commission Expires
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
tna ials and /or workmanship.
Date ______ __ _________
Notary Public, State of Florida
r
Plumbing Inspector.
Master Plumber.
JOB:
BUILDING
ELECTRICAL
PLUMBINB
WORK
: DOPE BY:
REUESTED WILL BE READY
1 7 /
The following is ready for inspection:- ./OD
Inspector's Report:-
OWNER
LOT
BLOCK
SUBDIVISION
Date ../0 ;
liked to } ✓Yr • r;
aiami Jhores
F L 0 R I D A
PLUMBING PERMIT N9 871
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in kliami Shores Village, Florida.
For a_story b uilding at i {, /
Fixtures
Fixtures $
Sewer $
Septic Tank / $ � - •-
• Total $
fr
Village Plumbing Inspector
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Received Payment by
OWNER
LOT
BLOCK
SUBDIVISION
Fixtures $
Sewer $
Septic Tank ' " $
aiami Jhores illage
F L 0 R I D A
PLUMBING PERMIT N9 871
Date
Issued to
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a I' story i building at
Fixtures
Total $
Village Plumbing Inspector
Received Payment by