8332MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
— -
Permit No. 7/.2 3 Z'
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 wow
Owner's Name and Address
No._ Street
Registered Architect and /or En ' er
Employing Plumber's Name t V"h'r'" 'f I, ° " -L*''e No._ _-__ Street_
Location and Legal Description Lot____ ___ _ __ ___ ________ ck� __ __________ Subdivision
Street and Number where work is to be performed —No._ . Z_Z2 __e____ _________ 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 Tank_
-- - -
Capacity Gals.___
Feet of Drain' Tile Dist. Feet of Tank or Drain Field from WeIL — __ - - _
Nature of Water Supply: City -Well _Size of Soakage Pit
Amount of Permit $_ • 7,�,,.
( Signed)._
umbing Inspectoa
The undersigned applicant for this building permit does hereby certify that he derstands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has
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 r public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be r performed under this permit; as are
licensed by Miami Shores Village.
(Signed) _ mil' ef/
7
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowled ents, personally appeared
Otin
ateF Piu}w
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 fauli
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS :
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUDIT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC.
TANK
SEWER -
CONN.
DRAIN ..SOAKAGE
FIELD PIT `.
GREASE.
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST..
CHECK
Size Septic Tank
— Type of Tank_
-- - -
Capacity Gals.___
Feet of Drain' Tile Dist. Feet of Tank or Drain Field from WeIL — __ - - _
Nature of Water Supply: City -Well _Size of Soakage Pit
Amount of Permit $_ • 7,�,,.
( Signed)._
umbing Inspectoa
The undersigned applicant for this building permit does hereby certify that he derstands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has
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 r public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be r performed under this permit; as are
licensed by Miami Shores Village.
(Signed) _ mil' ef/
7
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowled ents, personally appeared
Otin
ateF Piu}w
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 fauli
materials and /or workmanship.
4�+
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