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3105MIAMI SHORES VILLA PLUMBING INSPECTION DEPARTMENT ►PPLICATION FOR PLUMBING Permit Application is hereby made or the approval structure herein described. This application is and all provisions of the Laws of the State of of Miami Shores Village shad building during progress of wo Owner's Name and Address Registered Architect and / . ngineer Employing Plumber's Location and Legal I escriptrori Lot Street and Number where work to be pei State work to be performed New Building_ of the detailed statement of the plans and s made in compliance and conformity with Florida, all ordinances of Miami Shores Village and with, er herein specified or not. A copy of 4 pose of building (By Floors) Addition______ Repairs. BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP LAUNDRY SINKS TUBS URINALS GATCII BASIN DRAT FIEL SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM Tank Type of Tank Drain Tile– Dist. Feet of -Tank or Drain Field front y: City —. Well.______ of Soakag Nature of Water S Amount of Permit (Signed) The undersigned applicant for this building permit does hereby certify that h ' a derstands a> under the Florida Workmen's Compensation Act, being Section 5966, Compiled eral Laws of 9 plied with the provisions thereof, and will require similar compliance from all contractors or sub-c performed under this permit; and will post or cause to be posted for inspection on the site of t requited by the Act. The under signed agrees to employ only such sub -co ractors, ' on work licensed by Miami Shores Village. STATE OF FLORIDA, i COUNTY OF DADE, j ss. Before me, the undersigned authority, a notary public, duly . authorized appeared to me well known, and wbff, beiylg by me first duly sworn, upon oath &poses and of the above described construction, that be has carefully read the foregoing a therein by him stated are true. y Commission Expires NOTE: A re- inspection fee of $1.00 will be made materials and /or workmanship. ore employe i by bim n such re- inspection is made • Permit No MIAMI SHORES VILLAGE- PLUMBING INSPECTION DEPARTMENT PPLICATION FOR PLUMBING PERMIT. Application is hereby made for the approval of the detailed statement of the plans and specification& structure herein described. This application is made in compliance and conformity with the Buildi, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and ail Mules of Miami Shores Village shall be p ' with, er herein specified or not. A copy of approved building during progress of wo . Date_ Owner's Name and Address --•- -��� No 407'. -• Registered Architect and /o ngineer Employing Plumber's + `. . ... No.. • Location and Legal Description Lot Liock Street and Number where work, is to be performed—No Stmt State work to be performed and purpose of building (By. Floors) New Building Remodeling_- e________r__... Addition_ - Repairs ;red r Ate building f Mss ';: Vingite, . and regulations of $ui plans andVaificatiorks atAkst ire S CLOSETS BATH Tuts SHOWERS LAVA- TORIES SINKS SLOP SINES URINALS CATCH. BASIN s[tKftapt PouNrns TOTAL F,I XTVRES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAT FIEL SOAKAGE PtT GREASE TRAP SOLAR HEATER DEEP WELL SPRIG-R. SYSTEM SWIM'G POOL CONTR. LIST CHECK Size Septic Tank_ Type of :Tank Ca Feet of Drain Tile Dist. Feet of Tank or Drain Field from Nature of Water y: City —Well -- ------------- .--- __ - - - -- -.Size of Soakage Pit Amount of Permit $ { The undersigned applicant for this building permit does hereby certify that . ' &gonads and accepts 1406tgoior&ra '= ..employer of labor:... under the Florida Workmen's Compensation Act, being Section 5966, Compiled netal Laws of Florida Permanens Supplement, . and has Win- ;,: plied with the provisions thereof, and will require similar compliance from all contractors, or. sub -cow empboyed by hint is the woi:k -to be performed under this permit; and will post or cause to be posted for inspection on the site of shit wOrk sue. pt be .;souse or notices as -ars . requited by . the Act. The under signed agrees to employ only such sub -cod ctors, on work tai be isadta this per, as :: ate Homed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Tu Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take afedgments, to me well known, and who being by me first duly sworn, upon oath deposes and says that' he is 'tbe ---- of the above described construction, that he has carefully read the foregoing application, and tbtI* be # .ti,,,aign std that. all facts therein by him stated are true. appeared My Commission Expires • Notary Public. State of • ice' NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is nude accessary by imps . notice, materials and /or workmanship.