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1427Permit No 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 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 En_+'. Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No No Street__________ .... • - - -- No Street.._ Subdivision_- 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 Took Feet of Drain Tile _Dist. Feet of Tank or Drain Field from WeI__�__.,..__ Nature of Water Supply: City—Well. Size of Soakage Pit_______ Capacity Gals. -._- Amount of Permit $ ( Signed) Plumbing Inspector. The undersigned applicant for this banding permit does hereby certify that he understands and -pts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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 tlie Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Sh62113 Village. ( Signed) STATE OF FLORIDA, } COUNTY OF DADE. Master Plumber. tiamia- 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOW$ LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUHB URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK ..d.,N, SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP °IR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Correll. LIST CHECK. Size Septic Tank— Type of Took Feet of Drain Tile _Dist. Feet of Tank or Drain Field from WeI__�__.,..__ Nature of Water Supply: City—Well. Size of Soakage Pit_______ Capacity Gals. -._- Amount of Permit $ ( Signed) Plumbing Inspector. The undersigned applicant for this banding permit does hereby certify that he understands and -pts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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 tlie Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Sh62113 Village. ( Signed) STATE OF FLORIDA, } COUNTY OF DADE. Master Plumber. tiamia- 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.