490 NE 102 St (8)MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
0
Permit No R
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.
Jeremiah Mullane No Street__
Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name Rose Septic Tank, C'<<L ._p .a.. 21140,,,` .a.,1.eah 3g }...— -- -
Locatton and Legal Description Lot. 49 U N. Ir k> r e e t Subdivision. - .__
Street. ...._._..._..._._
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By Floors)
New Building.__.._._.._ - - Remodeling._.___..._ -___ Addition
Repairs. No. of Stories ....................
_ .. .Capacity Gals..
Size Septic Tank_.._ Type of Tangy
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 $
(Signed)-
(Signed)
M Coon E Notary Public, State of Florida
Muter Plumber.
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 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 u 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.
STATE OF FLORIDA, 1 µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep deposes and says that he is the _.__.._. - - -.
of the above described construction, that he has carefully read the foregoing application, and that be 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 whey stsoi misspend= le amde by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUB[
eNOW[RS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuns
UR
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUNT' NS
TOTAL
FIXTURES
CONTS.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
PIELD
1—
SOAKAGE
PIT
G
TRAP
SOLAR
HIATIR
DEEP
WELL
SYSTEM
SWIM'o
POOL
CONTR.
LIST
CHECK
42 t
_
I
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
0
Permit No R
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.
Jeremiah Mullane No Street__
Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name Rose Septic Tank, C'<<L ._p .a.. 21140,,,` .a.,1.eah 3g }...— -- -
Locatton and Legal Description Lot. 49 U N. Ir k> r e e t Subdivision. - .__
Street. ...._._..._..._._
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By Floors)
New Building.__.._._.._ - - Remodeling._.___..._ -___ Addition
Repairs. No. of Stories ....................
_ .. .Capacity Gals..
Size Septic Tank_.._ Type of Tangy
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 $
(Signed)-
(Signed)
M Coon E Notary Public, State of Florida
Muter Plumber.
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 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 u 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.
STATE OF FLORIDA, 1 µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep deposes and says that he is the _.__.._. - - -.
of the above described construction, that he has carefully read the foregoing application, and that be 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 whey stsoi misspend= le amde by improper notice for inspection, or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE, FLA. N? 6122
JOB 7 t •(7 P -- 6 G 40-
ADDRESS 4 " C t -1/1 5-- l o c� S
INSPECTION 1 20./
TIME READY 10 6 to 9 a i P LL&
REMARKS
INSPECTOR DATE
i
Permit No.- .._.....- _?_ (_s?
New Building Remodeling
Size Septic Tank
Feet of Drain Tile = —fit
Nature of Water Supply: City —Well.
�.�
ge
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
(Signed).
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 af. Ze_._� ____- _._ -__ No. __! L.Q.__ Street -2 ? .`7 z y.R
Registered Architect and /or Engineer__ /
Employing Plumber's Name c �4 1i f'�l -e.;- No../ _ 7---7-_- Y -_ - -.— Street_22_J4.) to
Location and Legal Description Lot___- _________________ __ _____-_-_-__ Bloc' Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)_
Addition Repairs No. of Stories ..........................
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
—
_Size of Soakage Pit
Capacity Gals.
Amount of Permit $ -- `- 1?_. __________ __._ - ___ -- — Y (Signed)--- ---•-_ 1 '"
My Commission Expires Notary Public, State of Florida
tip....± --
Plub bang 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 bus 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.
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 workmanship.
CLOSRB
BATH
TUBE
SHOWERS
LAVA-
Tomes
SINKS
SLOP
SINKS
LAUNDRY
TUBB
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'O
POOL
CoNTR.
LIST
CHECK
i
Permit No.- .._.....- _?_ (_s?
New Building Remodeling
Size Septic Tank
Feet of Drain Tile = —fit
Nature of Water Supply: City —Well.
�.�
ge
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
(Signed).
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 af. Ze_._� ____- _._ -__ No. __! L.Q.__ Street -2 ? .`7 z y.R
Registered Architect and /or Engineer__ /
Employing Plumber's Name c �4 1i f'�l -e.;- No../ _ 7---7-_- Y -_ - -.— Street_22_J4.) to
Location and Legal Description Lot___- _________________ __ _____-_-_-__ Bloc' Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)_
Addition Repairs No. of Stories ..........................
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
—
_Size of Soakage Pit
Capacity Gals.
Amount of Permit $ -- `- 1?_. __________ __._ - ___ -- — Y (Signed)--- ---•-_ 1 '"
My Commission Expires Notary Public, State of Florida
tip....± --
Plub bang 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 bus 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.
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 workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE. 19
❑- PERMIT N9 5765 Contractor's
License No. i
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description II Bl
CONTRACTOR OR BUILDER
Subdi-
vision
Address of Value of I Amount of
Building Project $ I Permit $
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 applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
Signed. 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 as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
ABBOT 3 '
Permit No
Amount of Permit $
Owner's Name and Address__
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —N
State work to be performed and purpose of building (By Floors
New Building Remodeling
Nature of Water Supply: City —Well
STATE OF FLORIDA, 1
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
• Date / V — s ll
Application is hereby mad 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.
Addition
(Signed).
(Signed)--
No. y___L 0 Street ,t c 1 D L '
No. — StrA &(Y. 1 �' .
Block Subdivision
Stree 1--
Repairs
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from 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.
My Commission Expires Notary Public, State of Florida
o. o S ries
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
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
.
.
CHECK
Permit No
Amount of Permit $
Owner's Name and Address__
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —N
State work to be performed and purpose of building (By Floors
New Building Remodeling
Nature of Water Supply: City —Well
STATE OF FLORIDA, 1
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
• Date / V — s ll
Application is hereby mad 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.
Addition
(Signed).
(Signed)--
No. y___L 0 Street ,t c 1 D L '
No. — StrA &(Y. 1 �' .
Block Subdivision
Stree 1--
Repairs
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from 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.
My Commission Expires Notary Public, State of Florida
o. o S ries
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.
BUILDING
ELECTRICAL
PLUMBING
a-
Owner of
Building
Architect
Contracto/ ((.
or Builder
Legal
Description
Address of
Building
Lot
ONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 6694
Work to be erformed under this Permit
Bl.
Subdi-
vision
BY
DATE
Contractor's
License No.
Value of a
Project
Amt. of
Permit
This permit is gra tes to the contra tor or builder named abo 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 w th 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 change without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the r sponsibility for a thorough knowledge of tbe'ordinances.and
e assumes respbn-
194_
regulations pertaining to the work covered hereby whether shown on the plans or drawings or the•stat'er ents or specifications and
sibility for work done by his agents, servants or employees. .4,,_ • e f 4q �i
Si ned `" ' `. _
�' By
/ INSPECTOR y )
In consideration of the issuance to me of this permit I agree to perform the w &rk covered hereunder in compliance with a1rordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, ate + +ents,oi specifications submitted to the proper authorities of Miami Shores Village.
In accepting tlw ume responsibility for all work done er js. r: If agent, servant or employee.
AUTHORITY
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ r Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tl(e buildiy other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vi11ag' lorida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Buildin i vision
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be at
building during progress of work.
0
-.F 2
Owner's Name and Address_ ui
__ _ _ _
" 0 n Street __
Registered Architect and /or Engineer
Employing Plumber's Name- -__ —e '____ _ ..L.__ - -_— __- -__ No
Street_
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
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
Feet of Drain Tile ,____, Dist. Feet of Tank or Drain Field from Well I
Vature of Water Supply: City —Well Size of Soakage Pit
mount of Permit $ (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
Br the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
' with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be
rmed 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
•ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
Id by Miami Shores Village.
OF FLORIDA,
V OF DADE.
ss.
•e me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
known, and who, being by me first duly sworn, upon oath deposes and says that he is • the
'e described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
im stated are true.
My Commission Expires
(Signed)
Notary Public, State of Florida
re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
or workmanship.
CLOSETS
B ATH
T UBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDR
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTI
FIXTUI
rr)NTR.
LIST
—.
CHECK
I
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
•
CONTR.
LIST
I CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._ r Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tl(e buildiy other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vi11ag' lorida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Buildin i vision
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be at
building during progress of work.
0
-.F 2
Owner's Name and Address_ ui
__ _ _ _
" 0 n Street __
Registered Architect and /or Engineer
Employing Plumber's Name- -__ —e '____ _ ..L.__ - -_— __- -__ No
Street_
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
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
Feet of Drain Tile ,____, Dist. Feet of Tank or Drain Field from Well I
Vature of Water Supply: City —Well Size of Soakage Pit
mount of Permit $ (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
Br the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
' with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be
rmed 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
•ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
Id by Miami Shores Village.
OF FLORIDA,
V OF DADE.
ss.
•e me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
known, and who, being by me first duly sworn, upon oath deposes and says that he is • the
'e described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
im stated are true.
My Commission Expires
(Signed)
Notary Public, State of Florida
re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
or workmanship.
OWNER
LOT
BLOCK
SUBDIVISI•
_y ,
r
4...."
•
f —
Issued to
For a_story
Fixtures
Fixtures
Sewer
•tic Tank
Total
Miami cShores9llage
r z o a i n w
LUMBING PERMIT N9 1173
1
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 an
drainage work done in ► iami Shores Village, Florida.
building at
Village Plumbing Inspector
Received Payment by
7(1/,z