349 NE 102 St (10)Permit No 1_,2- 72___
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_ - - ��k ' _
Registered Architect and /or Engin; r
Street and Number where work is to be performed —No
Size Septic Tank_
Feet of Drain Tile
Amount of Permit $_ fD __
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. 19 - - - -1"_ Street- - - -/ p az
Employing Plumber's Name " _ — No..__ — Street__
Location and Legal Description Lot_____________— ____ ^ Block
State work to be performed and purpose of building (By Floors) — — .-------- _---- -_ -_.�
New Building--- - -__ -_ - __- Remodeling Addition__ -_ Repairs No. of Stories.._ .._.. --- -•_ - -• • - --
Nature of Water Supply: City — Well.___ ___„.........
______ —__
Type of Tank_ __ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
( Signed) _
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-
plier 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 wPrk to be performed unjr this permit, as are
licensed by Miami Shores Village.
(Signed).
E Street /a a-
Date __�L-
My Commission Expires Notary Public, State of Florida
lu ing Ins ,ctor.
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 inspr:' on or faulty
materials and /or workmanship.
C1-"E"
BATH
TUBS
SHOWERS
WERS
LAVA
TORIES
S INKS
SLOP
SINKS
LAUNDRY
TUBS
U
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
SW IM'G
POOL
CONTR.
LIST
CHECK
-
Permit No 1_,2- 72___
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_ - - ��k ' _
Registered Architect and /or Engin; r
Street and Number where work is to be performed —No
Size Septic Tank_
Feet of Drain Tile
Amount of Permit $_ fD __
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. 19 - - - -1"_ Street- - - -/ p az
Employing Plumber's Name " _ — No..__ — Street__
Location and Legal Description Lot_____________— ____ ^ Block
State work to be performed and purpose of building (By Floors) — — .-------- _---- -_ -_.�
New Building--- - -__ -_ - __- Remodeling Addition__ -_ Repairs No. of Stories.._ .._.. --- -•_ - -• • - --
Nature of Water Supply: City — Well.___ ___„.........
______ —__
Type of Tank_ __ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
( Signed) _
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-
plier 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 wPrk to be performed unjr this permit, as are
licensed by Miami Shores Village.
(Signed).
E Street /a a-
Date __�L-
My Commission Expires Notary Public, State of Florida
lu ing Ins ,ctor.
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 inspr:' on or faulty
materials and /or workmanship.
Permit No 7/ 6 '
/
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING Now
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 k
8 uring progress rogresso work.
'�
Owner's �' Name and Address - _ n
= .1 f K- _ No._ - f- Street /7
Registered Architect and /or Engineer ..... ______
— ______
Employing Plumber's Name i S E2 __ -7 _
Location and Legal Description Lok_
Street and Number where work is to be
State work to be performed and purpose of building (By Floors)_
New Building Remodeling ___--- _- -------- _- _ --_.__ Addition
Block
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well ________ __Size of Soakage Pit
i ce C
------ - - - - -- - - - - - --
Capacity Gals.
(Signed)_
(Signed)._
Date_l_/_�_. ?, / `�
-n � _
Subdivision
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 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.
My Commission Expires Notary Public, State of Florida
M aster Plumber.
STATE OF FLORIDA, t s&
COUNTY OF DADE.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tung
U 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
$W IM'O
POOL
CONTR.
LIST
CHECK
Permit No 7/ 6 '
/
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING Now
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 k
8 uring progress rogresso work.
'�
Owner's �' Name and Address - _ n
= .1 f K- _ No._ - f- Street /7
Registered Architect and /or Engineer ..... ______
— ______
Employing Plumber's Name i S E2 __ -7 _
Location and Legal Description Lok_
Street and Number where work is to be
State work to be performed and purpose of building (By Floors)_
New Building Remodeling ___--- _- -------- _- _ --_.__ Addition
Block
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well ________ __Size of Soakage Pit
i ce C
------ - - - - -- - - - - - --
Capacity Gals.
(Signed)_
(Signed)._
Date_l_/_�_. ?, / `�
-n � _
Subdivision
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 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.
My Commission Expires Notary Public, State of Florida
M aster Plumber.
STATE OF FLORIDA, t s&
COUNTY OF DADE.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of C
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
❑
' J
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE ��� 195
PERMIT N? '716 6 Contractor's
License No.
Bl.
.1'
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 drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. ,,
f'' i 2 1
Signed.
Work to be performed under this Permit
re
r 43.
w
Subdi-
vision
Value of
Project $
Amount of
Permit $
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.
BY AUTHORITY
6
Permit No P�
Amount of Permit $
O 6
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
(Signed).
Repairs-_
Date 3- 3 _. .. - �
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 J H(_ ' __ t � Owner's Name and Address � � No. ` _ / N Street. S
Re Architect and /or
E Plumber's N am e �-
Location and Legal Description Lot_______ ._._.__._.__.. _ .__ ___ _ Block
Street and Number where work is to be performed —No 7 i / AIL
State work to be performed and purpose of building (By Floors)_
New Building _ -_ Remodeling --- ____ —__- Addition -.
No:_ 1 l,$ ' N /E" Street.
Subdivision
4 2_42 Street
No. of Stories
Size Septic Tank � 1 ______ Type of Tank
Feet of Drain Tile_______lA___11,�/�i__Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____ _ _____ _.Size of Soakage Pit
Capacity Gals
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 Ilas 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 > . of the wor ch public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractor -, on ork to b erforrped d:r this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 1 es.
COUNTY OF DADE.
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 workmanship.
CLOfRB
BATH
TUBS
SHOWERS
LAVA
TORIES
S
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
CNECK
-
Permit No P�
Amount of Permit $
O 6
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
(Signed).
Repairs-_
Date 3- 3 _. .. - �
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 J H(_ ' __ t � Owner's Name and Address � � No. ` _ / N Street. S
Re Architect and /or
E Plumber's N am e �-
Location and Legal Description Lot_______ ._._.__._.__.. _ .__ ___ _ Block
Street and Number where work is to be performed —No 7 i / AIL
State work to be performed and purpose of building (By Floors)_
New Building _ -_ Remodeling --- ____ —__- Addition -.
No:_ 1 l,$ ' N /E" Street.
Subdivision
4 2_42 Street
No. of Stories
Size Septic Tank � 1 ______ Type of Tank
Feet of Drain Tile_______lA___11,�/�i__Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____ _ _____ _.Size of Soakage Pit
Capacity Gals
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 Ilas 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 > . of the wor ch public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractor -, on ork to b erforrped d:r this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 1 es.
COUNTY OF DADE.
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 workmanship.
MIAMI. SHORES VILLAGE, FLORIDA
IG
CAL E R I T M N? 6'713 C
PLUMBING i`kense No.
Work to .be erfo -med under this Permit
Owner of
Building
12
Architect
Contracto j
or Builder ( Jll f&
Legal- Lot
Description
Address of
Building
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Value of
Project
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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil 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 • 1f"the stat meiits-or specifications aid' hat r 'assumes respon- •
sibility for work done by his agents, servants or employees. ) J / / ,
Signed • . `'� C 'l t : ..1 By f `mss
INSPECTOR''
In consideration of the issuance to me of this permit I agree to pert rm the ork covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statfements specifications submitted, to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by eithe - myself, my agent, servant or employee. -
BY
DATE
Amt. of
Permit
L
00
1942
1.0
1
W }
AUT RAW
Permit No._
Application is here made for the approval of the detailed statement of the plans and specifications herewith submit4ed 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 '
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $_ ( Signed)
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
Date
Street_l_1___ I e
Registered Architect and /or Engineer /
Employing Plumber's Name ���� °" � e t' No `? i Stree 14) . 4
Location and Legal Description Lot 1 f 1( 7 Block 3 Subdivision___ _i___C__ e
Street and Number where work is to be performed —No __ q Street'_1 e / 0
7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank
Capacity Gals
YP P Y
Feet of Drain Tile___ I 0 d ' Dilt. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —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 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.
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.
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 workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
U
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 here made for the approval of the detailed statement of the plans and specifications herewith submit4ed 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 '
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $_ ( Signed)
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
Date
Street_l_1___ I e
Registered Architect and /or Engineer /
Employing Plumber's Name ���� °" � e t' No `? i Stree 14) . 4
Location and Legal Description Lot 1 f 1( 7 Block 3 Subdivision___ _i___C__ e
Street and Number where work is to be performed —No __ q Street'_1 e / 0
7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank
Capacity Gals
YP P Y
Feet of Drain Tile___ I 0 d ' Dilt. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —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 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.
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.
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 workmanship.