375 NE 102 St (9)Nature of Water Supp ell
Amount of Permit $_
'Z
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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___.
Registered Architect and /or E
�`�
Employing Plumber's Name � _ � � 4'4/40.7_ Street_
Location and Legal Description ;1-• Block 7 Subdivision
Street and Number where work is to be performed—No. _ Street
No._
State work to be performed and purpose . of building (By
......._--_ -- Remodeling__ _____ Addition-_
. Size Septic Tank Type of Tank_ Capacity Gals
Feet of Drain Tile .__Dist. Feet of Tank or Drain Field from Well
Q
(Signed)
Repairs
Size of Soakage Pit
Date / 6 — 6 0
Street
No. of Stories_
Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his •ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and has cam -
plied with the provisions thereof, and will require similar compliance from all contractors or .sub-contractor 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.
(Signed - - - - -- - -- - - -
Master Plumber.
STATE OF FLORIDA,
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 worlQnanship.
CLOSETS
BATH'
TUBS
SHOWER!
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBB
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NB
TOTAL
FIXTURES
CONTR. L
LIST
'
/.
y
.
CHECK
.'
SEPTIC
TANK
SEWER
CONN.
DRAIN .
FI ELD
SOAKAGE
PIT
GREASE
TRAP
SQt'1e,
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
�T1�p
Cam✓
LIST
1
/
—
CHECK
Nature of Water Supp ell
Amount of Permit $_
'Z
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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___.
Registered Architect and /or E
�`�
Employing Plumber's Name � _ � � 4'4/40.7_ Street_
Location and Legal Description ;1-• Block 7 Subdivision
Street and Number where work is to be performed—No. _ Street
No._
State work to be performed and purpose . of building (By
......._--_ -- Remodeling__ _____ Addition-_
. Size Septic Tank Type of Tank_ Capacity Gals
Feet of Drain Tile .__Dist. Feet of Tank or Drain Field from Well
Q
(Signed)
Repairs
Size of Soakage Pit
Date / 6 — 6 0
Street
No. of Stories_
Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his •ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and has cam -
plied with the provisions thereof, and will require similar compliance from all contractors or .sub-contractor 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.
(Signed - - - - -- - -- - - -
Master Plumber.
STATE OF FLORIDA,
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 worlQnanship.