1155 NE 102 St (4)- -+
CLOSETS
BATH
Tuna
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TU.$
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
PHILO
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.. 4 ' Date... -.._.. 7 -
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.
Owners Name and Address Gavin 1 t • (P St . No
Registered Architect and /or Engineer S TT
Employing Plumber's Name ��e Hia eat'33014`, Na..�..,.e.......�....�...m. Itr .. .�...e.,:....�.....,....,��,.._
Location and Legal Description Lot.
Street and Number where work is to be performed —No 1 155 N _ F _ l 09nel gt r.e.eStreet.
State work to be performe8 and purpose of building (By Floors)__ —.__ New Building______ _ _.._..........._.. Remodeling —__ _.._. —. __ Addition.
Repairs No. of Stories.
Size Septic Tank_ 9 00W.Z21,Q s cl _ f t _ Type of Tank-- •__ —._.
Feet of Drain Tile slat. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit.
Capacity Cab.
(std) T; Np
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 Worlanen's Compensation Act, being Section 5988, 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 poster' 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 cab- oontractora, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Amount of Permit $ • 00
STATE OF FLORIDA, oa
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, dilly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly swan, 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 Erpirus Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa nth nispaotioa i. mods.aaoawry by improper notice for Inspection, or faulty
material and /or workmanship.