268 NE 102 St (13)Date
S v ,e �rreAAT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
1 _4 Job Address 2 6 g Ai 6. 0Z J Tax Folio
Legal Description // Historically Designated: Yes
/erk ki( �fEF1'c2
Owner/Lessee / Tenant
,ae9 IE‘ /
Contracting Co. )/ /k (' 4h 4
Owner's Address
Qualifier
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVIN FENCE SIGN I,,
WORK DESCRIPTION /D I !1(JL J2 / t-o�x, f /L / 27e
• 61'
Square Ft. Estimated Cost (value) ne 7Grt
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
•
�
IT
e of o
as O
Notary
Public
wner
and/or C
c.
o President Date
azy
My Cq
FEES: PERMIT
and/or Condo President
•
STEPHEN E COCKING
State of Florida
My Comm. Exp: 08/04/01
Comm#: CC669180
�nnnnneanr•ivv rannnnnnnA
RADON
APPROVED:
Zoning
Mechanical Plumbing
Building
ci- ac -cte
ate
Address
?-70 g qa2 7 7s
Phone °Z 7 75'
Address 'n9 5z -14-I. 2 ,
SS#
Competency # Ins. Co.
Address
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
Xtirenaefil
E COCKING
orida
Notary
Public
C.C.F. /..`.0 NOTARY
Master Permit #
Electrical
No
Phone ,3" 78-5
no
BOND
TOTAL DUE 8 6
Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 2668 Alt . / t Tax Folio
Legal ption Historically Designated: Yes /� No
Owner/Lessee / Tenant gi,„,,k f f� J�'� ' Master Permit # 4 70 g
Owner's Address
Contracting Co.
Qualifier / /heti 6 Th c ir'�
t/
State #
Square Ft.
,26g de to L s
7 C j;4 f 2ro4
tt —7 9'R
/Sign , ��f owner or Condo President Date
67o—`f7 — l 7/
Notary as
My Co
FEES: PERMIT
TEPHEN E COCKlNC.
State of Ftori3s
My Comm. Exp: 08/04!0
Comm#: CC888180
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Phone
Estimated Cost (value) /Oa
Electrical
7$/ —x_,_3
Address /.99 4 i ' z 111
SS# . Phone «o ,5/ i(s
Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
' Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION o ge7/4e.g. of^^eL 2/2›.4'"f e Jet
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner- Builder
/ 9j) Notary as to Contractor or Owner - Builder Date
My C.01nrnission Exp',
5 Y P ee-a6i
zte
4 � r� Q � MY COMMISSION EXP.
AFIMITION
17,1 , 98
C.C.F. t ;1151 NOTARY
o
Vg//,'
Date
BOND 5 W
TOTAL DUE400.6 0
Engineering
PROPERTY ID #:
L
D FILL REQUIRED: [ ] INCHES
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: ,` G G. s _
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID 4-
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT # %� 3
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
CO�NyTRUCTION PERMIT TR: l /T
[/V] New System [AI]/Existing System [ NJ }olding Tank Temporary/Experimental
[)/ ] Repair [PI Abandonment [ /t]/Other(Specify)
11
■ N, �,r
D
APPLICANT: J�_ / i""'/ �� / r✓07A 40.77 f AGEN 1'7 /, C S S� f T r
PROPERTY STREET ADDRESS: 244 41,./E: 41,./E: /0 a �� � r
LOT: /..)2 BLOCK: l f e i SUBDIVISION:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIgn_AND SFEgIFICATIONS
r - - /Q./.'Q % ■
T [Qc0 ] GALLON >/ G ] SEPTIC TAN EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ J PER 24 HRS NO. OF PUMPS: [ ]
D [ / SQUARE FEE
R [ ] •s FEET
A TYPE SYSTEM:
I CONFIGURATION:
F LOCATION OF BENCHMARK: /� r � / H/'1
I ELEVATION OF PROPOSED SYSTEM SITE [fO,
E BOTTOM OF DRAINFIELD TO BE [ $
RIMARY DRAINFIELD SYSTEM
SYSTEM
[ ] STANDARD [ ] FILLED [ ] MOUND
[ ] TRENCH
HRS Form 4016, Mar 92 (Obsoletes previous editions which may not .be.: used)
.._
(Stock Number: 5744 - 001 - 4016 - 0)
[lED [ ]
1"
[INCHES /FT] [ABOVE /BELOW] BENCH RK/REFERENCE POINT
INCH /FT] [ABOVEZ811 O BENCHMAR EFERENCE POINT
EXCAVATION REQUIRED: [ a ] INCHES
TITLE:
TITLE:
EXPIRATION DATE: 7 p ee
APPLICANT
[
Page
INSTRUC T :ONS:
PERMIT NUMBER: Permit tracking number assigned by CPI$U.
APPL :CATKCN FOR: Check type of permit, if "Oche." specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID 0 or section /township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANX: Minimum specifications from Chapter 1OD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low-volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED 3Y: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT t� /7M
Permit Application Number /�
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet. /01< -
miP.T_fizsmw r
irr-}
..
(
i
r
(
I
Agolut
a
C✓
N
Site Plan submitted by. ""-
Plan Approved
By
SIGNATURE
• Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC'HEALTH UNIT
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744- 002- 4015.6)
County Public Unit
Page 2 of 3
Permit No. _ --_
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or otlwi
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 Divisior
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_ ! - No. -__.._ ..
Location and Legal Description Lot---- ---.-••- - .......... __ ..... -_ -._ _ -- Block_____.._ _...- -_ - - -- Subdivision
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__.__ Repairs -.
Size Septic Tank._ ._ Type of Tank__
Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well
-_- Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(:
(Signed). -
•
•
Date
No._ Street
Street
Capacity Gals.
- street
-
No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as all employer of labor
under the Florida Workmen'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 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 an
licensed by Miami Shores Village. ■
(Signed).:
STATE OF FLORIDA, } ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 tau•
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 foul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOW[R6
LAVA-
TORIES
61NK6
SLOP
SINKS
LAUNDRY
TU58
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURE!
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 otlwi
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 Divisior
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_ ! - No. -__.._ ..
Location and Legal Description Lot---- ---.-••- - .......... __ ..... -_ -._ _ -- Block_____.._ _...- -_ - - -- Subdivision
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__.__ Repairs -.
Size Septic Tank._ ._ Type of Tank__
Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well
-_- Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(:
(Signed). -
•
•
Date
No._ Street
Street
Capacity Gals.
- street
-
No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as all employer of labor
under the Florida Workmen'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 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 an
licensed by Miami Shores Village. ■
(Signed).:
STATE OF FLORIDA, } ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 tau•
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 foul
materials and /or workmanship.
B1.11LVING
ELECT'R GA
PLUMBING
ROO NG
Owner o
Building
Architect
Contractor <. ,,,
or Builder
Legal
Description,
Address of
Building
MIAMI SHORES VILLAGE, O
FLRI �DA
Amt. of
Permit
Work to he :performed tinder this Permit
DATE //to 1„,•1‘,. 3 :195
deb' •
�' _ _, g 9 p ppj •on
This � erntt is ranted Co the conC•ractor ok ; �tlder. named , a'12o� �' eansttuct the - building or to install e • ui meat or device deseti�ed, in the a ltcat
berefor in strict compliance «rith -all ord nces pertaining, ulatio s
thereto the understanding :that the work. wit performed in compliance vY-iCh plans
g p l
d su�tn�"tted t'4 an a -cd ,by proper manic% pal authorities. This Permit ma4/ be revdked at any
rawtn s Stat ements 'or. s eciftcatio � that • � hake been,,
n i . P3' Changed i. o . ouh A, koowledge of the p his permit is
Cbe� ens are risen ed without authoza�atx"ozi. A further condition upon which t
time nted. the understanding a tha a o t a tot u an sd! a the r p oiT s ht a t
y f hz .ordinances and re
g b ibr g
: t he plans orr drawings- or in tie st.=tements or specsficatiop`s and that he Ames res s
' rbtlity for wd k
o
d n by e eots, s ants e or hereby'
ern t o e shawzA on ,
y g P Y '� '
t Signe-
In .consideration of the sssu'a �ce too° t Oh
of s; pert. i t 1 a
4 e. , "`, orm w
the ork covered hereunder ` . In c pli.ance with all ordinances and regulations
pertain` e • thereto and in strict co fdmtnity ro�ith tie ,plans, drawi0gs state tints or 'specifications bmitted to the !proper authorit'es oP Miami Shores Village.
In ac ^ ,'ing this permit I assu responsibility ,for ,all work done .b ither, self, my age erv.st or,em oyee.
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitt 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 I the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall lie
building during progress of work.
Owner's Name and Addre
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Eng __________ alf
Employing Plumber's Name _'�: /W
Location and Legal Description
Street and Number where work is
State work to be performed and
New Building
plied with the provisions thereof,
performed under this permit; and
required by the Act. The under
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
NOTE: A re- inspection fee
materials and /or workmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
complied with, whether herein specified or not. A copy of aRP yed. ,pia n s... and . - specifications- .m-ust be kept..at,
.4(e o.- - Z U Street- A 2 44 2L
_________________ ____r___ Subdivision__
to be performed —No.
purpose of building (By Floors)
Remodeling Addition Repairs________________ No. of Stories
Size Septic Tank_ - _ _ Type of Tank . Capacity Gals.--_-_-_- _______.
Feet of Drain Tile---- �__v_____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit ____________________________________ (Signed)
A
The undersigned applicant for this building permit does hereby certify that he understan a nd 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 corn-
and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
will post or cause to be posted for inspection on the site of the work such public notice or notices as are
signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
(Signed)
Date__
Street
My Commission Expires Notary Public. State of Florida
Plumbing Inspector.
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.
of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
CLOSETS
BATH
TUBS
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 submitt 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 I the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall lie
building during progress of work.
Owner's Name and Addre
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Eng __________ alf
Employing Plumber's Name _'�: /W
Location and Legal Description
Street and Number where work is
State work to be performed and
New Building
plied with the provisions thereof,
performed under this permit; and
required by the Act. The under
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
NOTE: A re- inspection fee
materials and /or workmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
complied with, whether herein specified or not. A copy of aRP yed. ,pia n s... and . - specifications- .m-ust be kept..at,
.4(e o.- - Z U Street- A 2 44 2L
_________________ ____r___ Subdivision__
to be performed —No.
purpose of building (By Floors)
Remodeling Addition Repairs________________ No. of Stories
Size Septic Tank_ - _ _ Type of Tank . Capacity Gals.--_-_-_- _______.
Feet of Drain Tile---- �__v_____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit ____________________________________ (Signed)
A
The undersigned applicant for this building permit does hereby certify that he understan a nd 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 corn-
and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
will post or cause to be posted for inspection on the site of the work such public notice or notices as are
signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
(Signed)
Date__
Street
My Commission Expires Notary Public. State of Florida
Plumbing Inspector.
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.
of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
Contractor's
License No. 1 0 0
.I 0 );3
ERMIT N9 3475
Work to be performed under this Permit
l
1
Bl.
Subdi-
vision
Was,,:It:bl: TM" tons;{ticuon may eta.
Wa, Production Board General Limitations :,
You are cautioned to consult your War P.oduc•ior
Board office before starting . _the work_ authorized is
'this permit' . / /f
Value of Amt. of
/D yv Project Permit /
BY
.
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 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 dra i�}gs r in the statements o speeifica and
that he assumes responsibility for work done by his agents, servants or employees 4' i*'
Signed • d - =
INSPECTOR if y
In consideration of the issuance to me of this ermit I agree to perform the work covered hereunder in.com liance wit r r'{)
P g P P dinances a � ��� ms -.
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the properrities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
VWNER
;`
OT
BLOCK
SUBDIVISION
,
e
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 story building at
p e P e ,J/ . 2 t -i :
Fixtures
C Fi yr t.- s ue i 7J - -i14' '
f Ai li $
ewer ,, ' / C. $ / 4) d
•tic Tank $
• Total $ / +d' e✓
iami chores9illage
F L O B D A
PLUMBING PERMIT N9 954
Village Plumbing Inspector
Received Payment by