Loading...
6749Permit No 74' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 11.) Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su 'bmitt ecf 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 '®� t Pif '4 VOA- 177f No Street Registered Architect and /or �E, Engineer /�� Employing Plumber's Name //L 1?1' BAOL / 1�I Si :" -fie- O 4 i' No.L. 0 A Streetit L? ty .- Location and Legal Description Lot Block Subdivision_ Street and Number where work is to be performed— No. - 7 7 sr Street....._-___ -_._- - - - -•- __-- State work to be performeS 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 TileJ .F • . mist_ Feet of Tank or Drain Field from Well___ Nature of Water Supply: City—Well. Size of Soakage Pit -- ____._____— .__�,__ Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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, . , . . k to be e.y, der this per t. y.. are licensed by Miami Shores Village. STATE OF FLORIDA, t 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 $L00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /cr worlmaanship. CLO86TS BATH TUBS SHOWER$ LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIB' CHECK - - -� SEPTIC TANK SEWER CONN. DRAIN FIELD .SOAKAGE PIT GREASE' TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Size Septic Tank_ Type of Tank ----- - -__�_ __ --------- _ -__ -- Capacity Gals Feet of Drain TileJ .F • . mist_ Feet of Tank or Drain Field from Well___ Nature of Water Supply: City—Well. Size of Soakage Pit -- ____._____— .__�,__ Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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, . , . . k to be e.y, der this per t. y.. are licensed by Miami Shores Village. STATE OF FLORIDA, t 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 $L00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /cr worlmaanship.