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4079Permit No (( MIAMI SHORES VILA AGE PLUMBING INSPECTION DEPARTMEW' APPLICATION FOR PLUMBING "4, Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tie building or other structure herein described. This application is made in compliance and conformity with the :.uilding 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 Employing Plumber's N Location and Legal Descri' tion Lot Blork No 47i Street- -t .- -- /70 f ' YaStreet Street and Number where work is to be performed —No Street_ State work to be performeS and purpose of building (By Flues) ----- New Building Remodeling Addition_ Subdivision No. of Stories___ _._... ... __...__... Size Septic Tank_ Type of Tank Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well Size of Soakage ' t_ //r `sue Capacity Gals. Amount of Permit $ Plumbing In 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 5988, 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 die Act. The undersigned agrees to employ only such sub - contractors work to be • rformed under this permit, as are licensed by Miami Shores Village. (Si STATE OF FLORIDA, 1 COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known;; and who, being by me first duly sworn, upon oathdeposes and. says that he is the of the above described construction, that he has carefully read the finegoing 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 $LOO will be made when such re- inspection is made.nocessary by improper notice for inspection, or faulty materials and /or wor p. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK! DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK `• SEPTIC " TANK SEWER CONN. DRAIN SOAKAGE FIELD PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW I tor O POOL CONTR. LIST . ,jy CHECK Size Septic Tank_ Type of Tank Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well Size of Soakage ' t_ //r `sue Capacity Gals. Amount of Permit $ Plumbing In 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 5988, 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 die Act. The undersigned agrees to employ only such sub - contractors work to be • rformed under this permit, as are licensed by Miami Shores Village. (Si STATE OF FLORIDA, 1 COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known;; and who, being by me first duly sworn, upon oathdeposes and. says that he is the of the above described construction, that he has carefully read the finegoing 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 $LOO will be made when such re- inspection is made.nocessary by improper notice for inspection, or faulty materials and /or wor p.