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11803Permit No l 5 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted f 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 Location and Legal Description Lot Street and Number where work is to be performed —No No No Street-__.__. Subdivision--___ Street__ State work to be performed and purpose of building (By Floors) New. Building Remodeling Addition_ Repairs No. of Stori Size Septic Tank-___ Feet of Drain Tile -3 a Nature of Water Supply: City—Well. Type of Tank Capacity Gab. ----_--.__ -- Feet of Tank or Drain Field from Well Size of Soakage Pit__ __ .-- _----- -- ______-___ - -._ - -- Amount of Permit $ (Signed)- Iir f Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige • • an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennan • . . pplement, 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. (Sigma) STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acicnowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath dept 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 $1.00 will be made when such re- inspection is made necessary by improper notice for insp . or faulty materials and /or workmanship. CLOSETS BATH • TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHICK 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-___ Feet of Drain Tile -3 a Nature of Water Supply: City—Well. Type of Tank Capacity Gab. ----_--.__ -- Feet of Tank or Drain Field from Well Size of Soakage Pit__ __ .-- _----- -- ______-___ - -._ - -- Amount of Permit $ (Signed)- Iir f Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige • • an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennan • . . pplement, 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. (Sigma) STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acicnowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath dept 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 $1.00 will be made when such re- inspection is made necessary by improper notice for insp . or faulty materials and /or workmanship.