9211Permit No
1
MIAMI SHORES VILLM E,
PL'U'MBING INSPECTION DEPARTMENT
APPLU'C,ATJON FOR PLUMBING PERMIT
e•
Date
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, alb' 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 wor.
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—No. /2 V •S E.
State work to be performed and purpose of building (By Floors )
New Building G,.$$' Remodeling Addition
Street / e t
-r Subdivision
7
street__''
Repairs_!
No. of
Size Septic Tank
Feet of Drain Tile Dist Feet of Tank or Drain Field from WeIL_
Nature of Water Supply
_Type of Tank Capacity Gals.--- _--- ____ --
Size of Soakage Pit__
Amount of Permit $ _10 $=..
(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
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 simla.' 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.
(Signed) l 0 1
STATE OF FLORIDA, 1
ss.
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 b me first duly sworn, upon oath deposes and says that he is they __ __ __________ ______ _____ _ ____________ _: _____
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 '',iuvhen such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
- TORIES -
i
. .11.4'' '
SLOP
SINKS
LAUNDRY
TUBS
j
, ATCH
"BASIN
FL.00,R
DRAIN
glarstKFNG
Fg.Uta is
J A., f *!ge
A
Mena r=
ddd
TOTAL
FIXTURES
CONTR.
LIST
+6
'aJ
r
®q
..
/
/
-
CHECK
tts^r`�∎-•
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE;
TRAO 1
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Size Septic Tank
Feet of Drain Tile Dist Feet of Tank or Drain Field from WeIL_
Nature of Water Supply
_Type of Tank Capacity Gals.--- _--- ____ --
Size of Soakage Pit__
Amount of Permit $ _10 $=..
(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
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 simla.' 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.
(Signed) l 0 1
STATE OF FLORIDA, 1
ss.
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 b me first duly sworn, upon oath deposes and says that he is they __ __ __________ ______ _____ _ ____________ _: _____
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 '',iuvhen such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
PERMIT N° 9211
to be per armed under this P.rmit
Owner of
Building
Architect
or Buildor
or Builder
Subdi-
vision
Value of
Project $
Amt. o
This permit is ggranted ter the contractor or budder named above io construct the building or to is
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that tb
drawings, statements or specifications that may have been submitted to and approved by the proper -ln+
time if the work is not done in compliance with such ordinances or if the plans are changed without l
granted is the understanding that the contractor or builder named above assumes the responsibility for
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or
done by his agents, servants or employees. r
Signed.
INSPHCTb*
In consideration of the issuance to me of this permit I agree to pe orm the work covered nce . , +• rdi
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper a. taf
In accepFing this permit I assume responsibility for all work done b ith .- ' yself, my agent, serval or employee