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30848Permit No. " F iCte MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date � -2 t -17 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 y of approved plans and specifications must be kept at building during the progress of work. Owner's Name and Address ,/�.� r 3' No. e 7 2- Street A/67 9g Registered Architect and/or Engineer j Bmplwing er' s �/�-� � d No. 7 Street �' 'ega lg gtion Lot 4- 7 4' fr 5 B lo Subdivision 7/45 !I performed — No. Street and Number where work is to be � c�0� V ✓ �(� Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs ,X No. of Stories Size Septic Tank Feet of Drain The Nature of Water Supply: City - Well Size of Soakage Pit 7sp / Type of Tank e�6e C Capacity Gals. Dist. Feet of Tank or Drain Field from Well 9J27 C,9-/ The undersigned applicant for this building permit does hereby certify that he understands and accepts his Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S thereof, and will require similar compliance from all contractors or sub - contractors employed by post or cause to be posted for inspection on the site of the work such public notice or notices as only such sub- contractors, on work to be performed under this permit, as are licensed by M. Plumbing Inspector ons as alemployer of labor under the t, and complied with the provisions under • will employ STATE OF FLORIDA, 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 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 $25.00 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 FOUNTAINS TOTAL FIXTURES CONTR. UST CHECK SEPTIC SEWER TANK CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G. POOL %NIL 1106;9-i aasod,41--- CHECK Size Septic Tank Feet of Drain The Nature of Water Supply: City - Well Size of Soakage Pit 7sp / Type of Tank e�6e C Capacity Gals. Dist. Feet of Tank or Drain Field from Well 9J27 C,9-/ The undersigned applicant for this building permit does hereby certify that he understands and accepts his Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S thereof, and will require similar compliance from all contractors or sub - contractors employed by post or cause to be posted for inspection on the site of the work such public notice or notices as only such sub- contractors, on work to be performed under this permit, as are licensed by M. Plumbing Inspector ons as alemployer of labor under the t, and complied with the provisions under • will employ STATE OF FLORIDA, 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 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 $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship.