133 NE 102 St (11)CLOSrrs
BATH
TUBS
SHOWER•
LAVA•
TORIES
SINK•
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
EASIN
FLOOR
DRAIN
t7RINKINO
FOUNT•N•
I
TOT,•L
FIKTI RE•
CONTR.
LIT
,
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
_
SPRKLR.
SYSTEM
SWIM
POOL
_ _ J
_
- -
CONTR.
LIST
i
CHICK
Penni, Nu. . t "1, 51 •-
:,pplts.,lum is hereby made for the approval of the detailed statement of the plans and specifications herewith subrnt• ,1 for the lauilding or other
tructure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi;• f Shores Village, Florida,
4,1d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic • of the Building Division
of Miami Shores Village shall be complied with, whether herein specified .or not. A copy of approved plans and spot fications must be kept at
'Iuilding during progress of work.
')wnei s Mune and Address _ -�.� —_� r._ ..__.._. _ ._ ��._.__ �_ Street ../.. . 5C !!
2 -
,cgistl red Architect and /or E eat
imploying Plumber's Name .. I�,_. - -i�`�
State work to be performed and purpose of building (By
New Building--- .- .....--- ._ .............. .... Remodeling
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
a..,, Street.....,,,.
Location and Legal Description Lot. Block
Street and Number where work is to be performed —No 1 i1 2J ' Street
Addition
a • .13
Repairs No of Stones
Size Septic Tank__._ — .------ ..._.-- .---- ._.- ____ -- ...Type of Tank Capacity Ails-
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 3_..`0. '� �• — (Signed)_. lS`�L..`-JJ 4U 0' V .. -s
^_ — — - Plumbin :; Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;llovei of ta1Kn
under the Florida Workrnen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Cum lement, and ha, , -l-
1 lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in rk v b�
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pub!' notice r no iccr rs a:
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed ',x this ,),rl.nit, .
licensed by Miami Shores Village.
STATE OF FLORIDA,
sa.
COUNTY OF DADE.
•
( Signed)- _— __.-_._.
Date _ ..i. 0._- ci
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per,orrt ; ppearet,
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 slgp the same, and teat all acts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
Mast 31 Plumber.
NOTE: A re inspection fee of $1.00 will be made when such re-inspection is made'neoessary by Improper notice for fnspect!on, or touity
materials and /or workmanship.
Name and address of licensed contractor.../ /
be sent to.
Remarks
Disapproved ..
(Signed)
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval pf the detailed statement of tile plans and specifications herewith submitted for the build •
ing 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 i3uilciing 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 the work.
Date T .
Owner's Name and Address .... 4 ' N 9 73 , No Street
r r
Registered Architect and /or Engineer . :,
: / .. ,••.,• •., ....
/ A.Qr .ecd/ ikt, ?) /L/ &' /G6 f1
Location and legal description of lot to be built on:
Lot Block Subdivision ._...._..
!�3 ..
Street and Number where work is to be done J'11 /o .S
,..__,
State work to be done and purpose of building (by floors) . `r`�1 r'r�D`-. t? tr.-r.. de / t„'
_._ and for no other purpose.
New Bui!ding Remodeling 1 Addition Repair; No. of Stories _
To be constructed of Kind of foundation , Covering . ..........
2 500. e, ................_.._�
Estimated Total cost of improvements $ ^mount of Permit $..1.. t .
Zone cubage required Plan Cubage , ,_.,.
Distance to next nearest building.. „ Size of Building Lot , .. , _........
Ma.xunum live load to be borne by each floor
I hereby sub it all a plans d specifications for said building. All notices with reference to the building and its construction may
v et o & /k
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Lib under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplem
and has complied w ith the rovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
in the work to be performe 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village,
Date
(Signe
•/ r
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, Personally ap-
peared
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 }rim stated are true. 4 ` �f C�
Permit No ' 1 [' Lk Date .......l.L 1� / / ._ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
19
to me well known,
PLANNING BOARD DATE
Chairman Member
Member _.. , Member ,
Member Member ._.._.....
Council Approved Date Disapproved , Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'Lannir,;; lto.ard.
A re.mspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or l;itulty
materials and/or workmanship.