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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. 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