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836 NE 100 StPermit No X7 y7 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 st building during progress of work. _ Owner's Name and Address Y� , £ , -=.-- `' Az No No. 4 Street/1 ! .. / O � Registered Architect and /or E ' eer — •••• Employing Plumber's Name �1L/ `�1�.1� /�.. 1 :, L »m.,.,...�.,...... Suletl. ..� >.-�C/ Location and Legal Description Lot r B Subdivision..-._ _ -- _.- -_- - -- Street and Number where work is to be performed -No ?3' / v ` _ /9® Street State work to be performed and purpose of building (By Floors) ._.__... - New Building _. Remodeling — __ — ...___ Addition Size Septic Tank_ .,------------- - - - - -- Type of Tank— Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. 1 es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) _ (Signed) Repairs Feet of Drain Tile._____ ____ __ _-Dist. Feet of Tank or Drain Field from Well. - Nature of Water Supply: City - Well __-- __-- _ - -_ -., ____ -__— __.Size of Soakage Pit Date .. 1 ? 4-/ L y .. g 2s Capacity Gals. 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 5986, 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 employ' . _ him In the work to be performed under this permit; and will post or cause to be posted for inspection on sit of the work such pu ' is n• . ce or not as are required by the Act. The undersigned agrees to employ only such sub-contract " " ri to , . per . rm under s pert as are licensed by Miami Shores Village. - 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 be did sign the same, and that all fads therein by him stated are true. My Commission Expires Notary Public, State of Flcrlda NOTE: A re- inspection fee of $1.00 will be made when eueh re•nspeetloo L made.neoessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH Tues SNOWERE LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'Ne TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK Cowrie. SEWER CONN. DR AIN FIELD ` mo w SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL ' ez_c)c � LIST CHECK Permit No X7 y7 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 st building during progress of work. _ Owner's Name and Address Y� , £ , -=.-- `' Az No No. 4 Street/1 ! .. / O � Registered Architect and /or E ' eer — •••• Employing Plumber's Name �1L/ `�1�.1� /�.. 1 :, L »m.,.,...�.,...... Suletl. ..� >.-�C/ Location and Legal Description Lot r B Subdivision..-._ _ -- _.- -_- - -- Street and Number where work is to be performed -No ?3' / v ` _ /9® Street State work to be performed and purpose of building (By Floors) ._.__... - New Building _. Remodeling — __ — ...___ Addition Size Septic Tank_ .,------------- - - - - -- Type of Tank— Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. 1 es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) _ (Signed) Repairs Feet of Drain Tile._____ ____ __ _-Dist. Feet of Tank or Drain Field from Well. - Nature of Water Supply: City - Well __-- __-- _ - -_ -., ____ -__— __.Size of Soakage Pit Date .. 1 ? 4-/ L y .. g 2s Capacity Gals. 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 5986, 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 employ' . _ him In the work to be performed under this permit; and will post or cause to be posted for inspection on sit of the work such pu ' is n• . ce or not as are required by the Act. The undersigned agrees to employ only such sub-contract " " ri to , . per . rm under s pert as are licensed by Miami Shores Village. - 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 be did sign the same, and that all fads therein by him stated are true. My Commission Expires Notary Public, State of Flcrlda NOTE: A re- inspection fee of $1.00 will be made when eueh re•nspeetloo L made.neoessary by improper notice for inspection, or faulty materials and /or workmanship. 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 �� � No.__ Vfi lo -/ __ Street J/! / 0 s Registered Architect and /or Enginee ___. —_� ��___ Employing Plumber's Name .1 �_ ' No. 511.3 Street--,[ k'' s f .5 r Location and Legal Description Lot____-.-_ ..... _- __.- ___- _-- _- _- _____._._ Block Subdivision Street and Number where work is to be performed —No r3 is Street d/AE . /AE 14 0 5 State work to be performed and purpose of building (By Floors) New Building _- _-- _---- _ -_ - -- . Remodeling Size Septic Tank Feet of Drain Ti19L CZ (/ # __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well._:____________ _ ... ______________________Size of Soakage Pit Amount of Permit $_______ ' i t STATE OF FLORIDA, sa COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition Repairs No. of Stories Type of Tani: -_ Capacity Gals (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 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. Date , /3 /.(_._,., 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. My Commission Expires 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 faulty materials and /or worlananship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TU BE URINALS RINALS 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 SW IM'G POOL CONTR. LIST CHECK - i 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 �� � No.__ Vfi lo -/ __ Street J/! / 0 s Registered Architect and /or Enginee ___. —_� ��___ Employing Plumber's Name .1 �_ ' No. 511.3 Street--,[ k'' s f .5 r Location and Legal Description Lot____-.-_ ..... _- __.- ___- _-- _- _- _____._._ Block Subdivision Street and Number where work is to be performed —No r3 is Street d/AE . /AE 14 0 5 State work to be performed and purpose of building (By Floors) New Building _- _-- _---- _ -_ - -- . Remodeling Size Septic Tank Feet of Drain Ti19L CZ (/ # __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well._:____________ _ ... ______________________Size of Soakage Pit Amount of Permit $_______ ' i t STATE OF FLORIDA, sa COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition Repairs No. of Stories Type of Tani: -_ Capacity Gals (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 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. Date , /3 /.(_._,., 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. My Commission Expires 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 faulty materials and /or worlananship. 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 -4 ' 1- - Registered Architect and /or Engineer �� N t,. ,✓ Employing Plumber's. Name__r�A_et_�__� _ � �j4-�_ �..,__ o.._... . 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)_ Size Septic Tank. _ __.- ---- ------ -- _ . _ - __ - . Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ I Ste STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Ni Block Date Street My Commission Expires Notary Public, State of Florida 9'ir3 S —_ . Z Z -': /1✓ Street ----- .-.-- ---- .._..__- •- --._.. Subdivision. Street New Building ___ Remodeling_ _____.__________________ Addition Repairs No. of Stories Type of Tank Capacity Gals. .... _Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit 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 bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed) - - --- 'e.- 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 worlananship. CLOSETS BATH TUBS N W 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 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 -4 ' 1- - Registered Architect and /or Engineer �� N t,. ,✓ Employing Plumber's. Name__r�A_et_�__� _ � �j4-�_ �..,__ o.._... . 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)_ Size Septic Tank. _ __.- ---- ------ -- _ . _ - __ - . Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ I Ste STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Ni Block Date Street My Commission Expires Notary Public, State of Florida 9'ir3 S —_ . Z Z -': /1✓ Street ----- .-.-- ---- .._..__- •- --._.. Subdivision. Street New Building ___ Remodeling_ _____.__________________ Addition Repairs No. of Stories Type of Tank Capacity Gals. .... _Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit 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 bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed) - - --- 'e.- 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 worlananship. MIAMI SHORES VILLAGE, FLA. N° 5400 JOB fig/ 17 -7 ,2 r c 5 i - A ADDRESS Cf ? L /U- c o o S INSPECTION A-, 1,1 R TIME READY °- 6-- (21 2 — REMARKS: - 11- - Z a_ INSPECTOR 1 -2,-1 Pi" DATE Miami, Fla., Apr11..3.,1957 Please...Issue... Permit. .. Ram' IN ACCOUNT WITH LAKE St SHAW WELL MRILLING GI . lanur atisfartinn is .r: 9335 N. W. 22ND AVENUE PHONE PL 9 -5523 —.....4--TERMS: NET CASH.--L_- 1..2" Well Massie 836 N.S. 100 Street ur Gnat 195.... BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE. FLORIDA ❑ PERMIT N° 5283 Owner of Lr ti Building t V� ::> cg o _ fete 4 t Architect Contractor ,; or Builder ` ' Legal Lot Description Address of Building CONTRACTOR OR BUILDER iN f ti €r` Bi Work to be performed under this Permit V�ry , "r . DATE 4" ° "- 195 ,7 Contractor's License No. t e Subdi- vision Value of Project $ Amount of '=r Permit $ 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 prope &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 adthorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. _ U ,.,' " BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered' overe l hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot 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: 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 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. CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 4750 mosvlig B1 Work to be performed under this Permit Subdi- vision Value of Amount of Project $ I I Permit $ BY DATE 195 Contractors License No. AUTHORITY e Permit N 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_._ 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____ ____ Addition._ Size Septic Tank. Feet of Drain Tile. Nature of Water Supply: City -Well. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING " i:dArr __Type of Tank .-Dist. Feet of Tank or Drain Field from Well .S' e of So : ge Pit 2 ---- ____ -_ /t:' v No. -- - - - Street•-- - Block �l __________ -__ -- Subdivisio (Signed) (Signed) o.,l a-la Street Repairs 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 bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. _ 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 he 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 worlomanship. 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 SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit N 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_._ 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____ ____ Addition._ Size Septic Tank. Feet of Drain Tile. Nature of Water Supply: City -Well. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING " i:dArr __Type of Tank .-Dist. Feet of Tank or Drain Field from Well .S' e of So : ge Pit 2 ---- ____ -_ /t:' v No. -- - - - Street•-- - Block �l __________ -__ -- Subdivisio (Signed) (Signed) o.,l a-la Street Repairs 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 bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. _ 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 he 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 worlomanship.