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868 NE 100 St (11)4 0 r4' MIAMI SHORES rNILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT PA:::;it N. .[ Date __V _J _-- '1_ / ! �J Application is hereby ma& 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 Pf k. � � c A / f Owner's Name and Address _ L^632 __�_-------- __ -• - -_ No.__� -L�'___� Street Registered Architect and /or Engineer Q -- Employing Plumber's Name.�lV!_I_t_1.NA_t _ s _rLlkfQ__ _ _ < <_ No.______ __/� N t ‘"C".6 - -- -- -- -- -- _AZ � �.j;A __ -___ -- Street__ ._ 3 7" Location and Legal Description Lot____________________ ______ Block Subdivision Street and Number where work is to be performed —No � �4,�s State work to be performed and purpose of building (By Floors)_..... i g " � / /(�/`�� /�)) r S j w treek /per \r L /wy Repairs S/ No. of Stories - New Building -- __-_ -- -•-- __-_ -- Remodeling_..__ _..__.__ Addition Size Septic Tank _ Type of Tank Capacity Gals Feet of Drain Tile____ _______.__Dist; Feet of Tank or Drain Field from Well _ • Nature of Water Supply: City — Well._______ ` Amount of Permit $ to My Commission Expires Size of Soakage Pit - (Signed)_ The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennan plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors performed under this permit; and will post or cause to be posted for inspection on the site of the wor required by the Act. The undersigned agrees to employ only such sub- contractors, ork to licensed by Miami Shores Village. (Signed Notary Public, State of Florida Plumbing Inspector. ations as an employer of labor nt gupplement, and has min- d by him in the work to be blic notice or notices as • are ed under this permit, as are aster Plumber. STATE OF FLORIDA, I 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. CLOUTS BATH Tues 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 4 0 r4' MIAMI SHORES rNILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT PA:::;it N. .[ Date __V _J _-- '1_ / ! �J Application is hereby ma& 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 Pf k. � � c A / f Owner's Name and Address _ L^632 __�_-------- __ -• - -_ No.__� -L�'___� Street Registered Architect and /or Engineer Q -- Employing Plumber's Name.�lV!_I_t_1.NA_t _ s _rLlkfQ__ _ _ < <_ No.______ __/� N t ‘"C".6 - -- -- -- -- -- _AZ � �.j;A __ -___ -- Street__ ._ 3 7" Location and Legal Description Lot____________________ ______ Block Subdivision Street and Number where work is to be performed —No � �4,�s State work to be performed and purpose of building (By Floors)_..... i g " � / /(�/`�� /�)) r S j w treek /per \r L /wy Repairs S/ No. of Stories - New Building -- __-_ -- -•-- __-_ -- Remodeling_..__ _..__.__ Addition Size Septic Tank _ Type of Tank Capacity Gals Feet of Drain Tile____ _______.__Dist; Feet of Tank or Drain Field from Well _ • Nature of Water Supply: City — Well._______ ` Amount of Permit $ to My Commission Expires Size of Soakage Pit - (Signed)_ The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennan plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors performed under this permit; and will post or cause to be posted for inspection on the site of the wor required by the Act. The undersigned agrees to employ only such sub- contractors, ork to licensed by Miami Shores Village. (Signed Notary Public, State of Florida Plumbing Inspector. ations as an employer of labor nt gupplement, and has min- d by him in the work to be blic notice or notices as • are ed under this permit, as are aster Plumber. STATE OF FLORIDA, I 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.