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9294MIAMI SHORES VILLAGE PI!UMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT'' • Permit No 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, 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 Engineer Employing Plumber's Name___'_'`s_" Location and Legal Description Lot_ Street and Number where work is to be performed —No ��� . State work to be performed and purpose of building (By Floors _- No. Street_ N o . — ?' Street_— -- — — - -- Subdivision_ _ -_- -------- __ -__- Tz Street_' 1 • New Building_____ ___________ _ Remodeling_ Addition_ Repairs_ No. of Stories____ Size Septic Tank__ el ) Type of Tank Feet of Drain Tile' ��' ___ __ ^� Dist. Feet of Tank or Drain Field from WeIL Nature of Water Supply: City —Well Size of Soakage Pit_ Amount of Permit $ , , : : _Capacity Gals._ / (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 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. STATE OF FLORIDA, ss. COUNTY OF DADS. ( Signed 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 be did sign the same, and that all facts therein by him stated are true. My Conunission Expires Notary' Public, State of Florida • Ali 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 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 Size Septic Tank__ el ) Type of Tank Feet of Drain Tile' ��' ___ __ ^� Dist. Feet of Tank or Drain Field from WeIL Nature of Water Supply: City —Well Size of Soakage Pit_ Amount of Permit $ , , : : _Capacity Gals._ / (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 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. STATE OF FLORIDA, ss. COUNTY OF DADS. ( Signed 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 be did sign the same, and that all facts therein by him stated are true. My Conunission Expires Notary' Public, State of Florida • Ali 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 BUILDING ELECTRICAL PLUMBING DR ID DAT Contra, License Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description. Address of Building Subdi- vision Value of 1� Amt of Project $ 1 Permit Thae permit is ggrraanated to the contractor or bmlder named above to construct the building or to f herefor io rict comphanoe with all ordinances pertaining thereto and with the understanding that the work drawingOtatements or specifications that may have been submitted to and approved by the proper municipal autism time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A granted is the understanding that the contractor or builder named above assumes the responsibility , r a thorough knowla pertaining to the work covered hereby whether shown on the plan on, slr( awing = or in the'statetn w or specifications and done by his agents, servants or employees. Signed': INSPECTOR. In consideration of the issuance to me of this permit I agree perform the work covered hereunder in colnpl pertaining thereto and in strict conformity with the plans, drawings,is tements or specifications submitted to the pro, In accepting this per I assume reAmonsib y for /11 work done by either, myself, my agent, servant or employee.' GONTRACTOR`1