1041 NE 93 St (3)Architect
Contractor
or Builder_
Legal Lot II BI.
Description
BUILDING ❑ DATE 195
ELECTRICAL ❑ PERMIT N° 1'6005 Contractor's
PLUMBING [] License No
ROOFING ❑ Work to be performed under this Permit
Owner of
Building
Address of
Bui.lding 1,/
CONTRACTOR OR BUILDER
MIAMI SHORES ViLLAEBE F"L®RO®A
Subdi-
vision
Value of
Project $
Amt. of
Permit $
This permit is granted to the contractor or builder named above to cons.:ruct the building or to install the equipment or device described in the application
bereior in strict compliance with all ordinances pertaining thereto and with tl-,e understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and apt roved by the proper municipal authorities. This Permit may be revoked at any
time ii the work is not done in compliance with such ordinances or if the plans :,re changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assums the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
dor.r by his agents, servants or employees.
Signed: i i BY.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perforn, the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No.
Amount of Permit $_
ge
Size Septic Tank_.
- _ .-
Nature of Water Supply. City—Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOlt PLUMBING PERMIT
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
/
No /6 ] Street dv e
Owner's Name and Address
Registered Architect and /or Engi . � a _
�- ,
Employing Plumber's Name ___ _ ,-4 - No._ , . -_ _ _ Street - - 1 4) & ? .. gi% �j a._-
. . / s > __ _
Location and Legal Description Lot_.__._ _ .1 Block___._ ._ Subdivision__ fy �
Street and Number where work is to be performed— No..__4 -. --L._-_.._____ Street-. & 6a y,- �, perforate
State work to be perforate and purpose of building (By Floors)_._ --- .......
New Building. .. Remodeling Adiition . Repairs. ..._.._ ..
/Type of Tank_ _ '�� (_ g
Feet of Drain Tile _. ' / <� 4 -a w� �t. Feet of Tank or Drain Field from Well
t —Well _.Size of Soakage Pit.
Plumbing Inspec
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employs of labo
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has co
plied with the provisions thereof, and will require similar compliance f rom 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 in mention on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such nub- contractors, on work to be performed under this permit, as art
licensed by Miami Shores Village.
( Signed
)_,l_.ir
Date
Capacity Gals.
3
No. of Stories
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appears
to me well known, and who, being by me first duly sworn, upon oath &> se
os 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 tau
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
OT A r e- inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or Lill
m e rials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAJNDRY
1'U88
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE!
Comm.
LIST
--
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
CHECK
n
Permit No.
Amount of Permit $_
ge
Size Septic Tank_.
- _ .-
Nature of Water Supply. City—Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOlt PLUMBING PERMIT
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
/
No /6 ] Street dv e
Owner's Name and Address
Registered Architect and /or Engi . � a _
�- ,
Employing Plumber's Name ___ _ ,-4 - No._ , . -_ _ _ Street - - 1 4) & ? .. gi% �j a._-
. . / s > __ _
Location and Legal Description Lot_.__._ _ .1 Block___._ ._ Subdivision__ fy �
Street and Number where work is to be performed— No..__4 -. --L._-_.._____ Street-. & 6a y,- �, perforate
State work to be perforate and purpose of building (By Floors)_._ --- .......
New Building. .. Remodeling Adiition . Repairs. ..._.._ ..
/Type of Tank_ _ '�� (_ g
Feet of Drain Tile _. ' / <� 4 -a w� �t. Feet of Tank or Drain Field from Well
t —Well _.Size of Soakage Pit.
Plumbing Inspec
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employs of labo
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has co
plied with the provisions thereof, and will require similar compliance f rom 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 in mention on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such nub- contractors, on work to be performed under this permit, as art
licensed by Miami Shores Village.
( Signed
)_,l_.ir
Date
Capacity Gals.
3
No. of Stories
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appears
to me well known, and who, being by me first duly sworn, upon oath &> se
os 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 tau
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
OT A r e- inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or Lill
m e rials and /or workmanship.
Permit No 720<r
6VHAMI SHORES VILR,AG
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOIL PLUMBING °" n•.MIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall he complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at
building during progress of work.
Owner's Name and Address C r.9 ne C o n s t , C O -- --- -• - __ - No.__- 1041 Street
Registered Architect and /or Engineer____-_.. - -- -------------_-_---... ____- __.___---
Employing Plumber's ______�it: r— _re .... No.-- _--- _-- _ - - - -- Street_---- -
Location and Legal Description Lot_- -Ez._ Lot_ 10;_ E2 Lot �] 1 Subdivision Hamilton Terrace
Street and Number where work is to be performed- No._.-________ 10 L 1®- __-____ - -_- Street_ N0 M i a m i Avenue
State work to be performed and purpose of building (By Floors)_______
New Building X Remodeling_ Addition____ Repairs
Size Septic Tank 700 gal Type of Tank___ . !' O a$ t concrete
Feet of Drain Tile_ )2 9 block i . Feet of Tank or Drain Field from Well
Nature of Water Supply: City -Well - __._ -.Size of Soakage Pit
Amount of Permit $ -- - - - - -- — - - -- (Si _ --���
(Signed).
Date Jan. 6, 1960
Capacity Gals. 700 X31,
No. of Stories.
NIT, 93 st
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certi Ey that he understands and accepss'his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Flori a'Percnanent 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 the Act. The undersigned agrees to employ only such suu- contractors, on . ork to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plu er.
STATE OF FLORIDA,
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
thereiL, by hits stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TIIBB
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK NG
FOUNT •NS
TOTAL
FI %TORES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•G
POOL
CONTR.
LIOT
-
CHUCK
Permit No 720<r
6VHAMI SHORES VILR,AG
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOIL PLUMBING °" n•.MIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall he complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at
building during progress of work.
Owner's Name and Address C r.9 ne C o n s t , C O -- --- -• - __ - No.__- 1041 Street
Registered Architect and /or Engineer____-_.. - -- -------------_-_---... ____- __.___---
Employing Plumber's ______�it: r— _re .... No.-- _--- _-- _ - - - -- Street_---- -
Location and Legal Description Lot_- -Ez._ Lot_ 10;_ E2 Lot �] 1 Subdivision Hamilton Terrace
Street and Number where work is to be performed- No._.-________ 10 L 1®- __-____ - -_- Street_ N0 M i a m i Avenue
State work to be performed and purpose of building (By Floors)_______
New Building X Remodeling_ Addition____ Repairs
Size Septic Tank 700 gal Type of Tank___ . !' O a$ t concrete
Feet of Drain Tile_ )2 9 block i . Feet of Tank or Drain Field from Well
Nature of Water Supply: City -Well - __._ -.Size of Soakage Pit
Amount of Permit $ -- - - - - -- — - - -- (Si _ --���
(Signed).
Date Jan. 6, 1960
Capacity Gals. 700 X31,
No. of Stories.
NIT, 93 st
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certi Ey that he understands and accepss'his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Flori a'Percnanent 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 the Act. The undersigned agrees to employ only such suu- contractors, on . ork to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plu er.
STATE OF FLORIDA,
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
thereiL, by hits 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 faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE 195
ELECTRICAL ❑ PERMIT N? 15188 Contractor's
PLUMBING ❑ License No
ROOFING ❑ Work to be performed under this Permit
Owner of t
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
BI.
Subdi-
vision.'
Value of
Project $
This permit is granted to the contractor or builder named above to const: uct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining` thereto and with tilt understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans a) e changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings, or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. F.
Signed: BY
Amt. of
Permit $
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining' thereto and in strict conformity with the plans, drawings, Statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, m :rself, my agent, servant or employee.
CONTRACTOR OR BUILDER � 13Y AUTHORITY
Permit No.
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 m 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 Divisior
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 E
Employing Plumber's Name
Location and Legal Description Lot -_IL. ll . 1� Bloch__ - .
Street and Number where work is to be performed —No. 1 � L
State work to be performed and purpose of building (By Floors)
1 /(z
New Building
Amount of Permit $_
STATE OF FLORIDA, ss.
COUNTY OF DADE.
ineer
Mg < :; y 6 SHORES VIILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FCIR PLUMBING PERMIT
No Street
a
e
Size Septic Tank Type of Tank_.-
Feet of Drain Tile ...... __ -- l ®ist. Feet of Tank or Derain Field from Well
Nature of Water Suppl : Ctty Well O _ _. Size of Soakage Pit.
- -__. —• _ (Signed)__
(Signed)
Date
Remodeling _ Ad$tion_ Repairs_.
No. of Stories
Capacity Gals.
Plumbing I peetor.
The undersigned applicant for this building permit does hereby certify that a 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 Pennanent 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 the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as art
licensed by Miami Shores Village.
� D
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath dI poses 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 fay
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 haul
materials an,workmanship.
CLOSETS
BATH
TueS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
L/.UNDRY
rues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' Ns
7/
G "" -1
TOTAL
FIIITUREI
CONTR.
LIST
O
�l
I
,
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
DEEP
NILL
SPRKLR.
SYSTEM
$W IM'
POOL
P47,6' i
e
� -
4 _.'
J
v�J
C LIBT
CHECK
.1
Q H HE EATEER
J // a.
C,
, 5 0
Permit No.
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 m 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 Divisior
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 E
Employing Plumber's Name
Location and Legal Description Lot -_IL. ll . 1� Bloch__ - .
Street and Number where work is to be performed —No. 1 � L
State work to be performed and purpose of building (By Floors)
1 /(z
New Building
Amount of Permit $_
STATE OF FLORIDA, ss.
COUNTY OF DADE.
ineer
Mg < :; y 6 SHORES VIILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FCIR PLUMBING PERMIT
No Street
a
e
Size Septic Tank Type of Tank_.-
Feet of Drain Tile ...... __ -- l ®ist. Feet of Tank or Derain Field from Well
Nature of Water Suppl : Ctty Well O _ _. Size of Soakage Pit.
- -__. —• _ (Signed)__
(Signed)
Date
Remodeling _ Ad$tion_ Repairs_.
No. of Stories
Capacity Gals.
Plumbing I peetor.
The undersigned applicant for this building permit does hereby certify that a 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 Pennanent 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 the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as art
licensed by Miami Shores Village.
� D
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath dI poses 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 fay
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 haul
materials an,workmanship.
?'?
7 °I
•
Date
Legal Description
Elf Owner/L essee / Tenant C. t I A S [J E
Owner's Address IO 4 I " 2- 9 3 S T
Contracting Co. • S ? o I` S6 J-1 (
Qualifier 1D8n 0 Imo•.. SS# % Phone 3o5 (053-- Sep
State #C accaci�3
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL /,
WORK DESCRIPTION S 'T 1 I CC U CR) G1 i /1
Square Ft. Estimated Cost (value) '(7/7
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all Laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOL: ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be d.. - in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the <<bove -named contractor to do the w' ° ated.
- lc/ r 77 7<it
•• ! ture of ' . act.. or Owner- Builder
Signature of owner and/or Condo President Date Si
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address Ic)q( e 9 3 S Tax Folio
F
\ PO, O
P nY FICIAL NOTARY SEAL
<. KAREN NEICE
21� COMMISSION NUMBER
< CC405983
COMMISSION EXP.
0F F r o ,• EPT 8 1998
Municipal #
RADON
C.C.F.
Address
Address
Address
APPROVED:
Zoning Building
Mechanical Plumbing
Historically Designated: Yes No
Master Permit # 93 1 / t /
Phone 7305 - ) b3O
Address 3D q k ( it) r O ST L). 4 3
Competency # Ins. Co. 644£ (t) fvl SUB 0
MECHANICAL ROOFING PAVING FENCE SIGN
-/7 -98
Notary as to Contractor or Owner - Builder Date
My Commission Expires: Pt/6, Karen Neice
,., IA Commission # CC 765999
,a iiii
v . Expires SEP, 8, 2002
BONDED THRU
9 OF rr` ATLANTIC BONDING CO., INC.
NOTARY BOND
Electrical
TOTAL DUE
Date
Engineering
■•v■••• ■.•ri•.Y■ ■. •• ��•Yr
Customer Agrees: g Sears assumes the customer's existing
facilities.are up to code and can accommodate a standard installation.
it additional work is required to meet this ;tens, it will be the
customer's responsibility; Any additional cha II be quoted and
approved prior to the start of Ole job.
Sears Installation Warranty: IN ADDITION TO ANY WARRANTY INTENDED TO YOU
ON THE SEARS MERCHANDISE INVOLVED, WHICH WARRANTY BECOMES EFFECTIVE
THE DATE THE MERCHANDISE IS INSTALLED, SHOULD THE WORKMANSHIP OF ANY
SEARS ARRANGED INSTALLATION PROVE FAULTY WITHIN ONE YIAR, SEARS WILL,
UPON NOTICE FROM YOU, CAUSE SUCH FAULTS TO BE CORRECTED AT NO ADDI.
TIONAL COST TO YOU.
ADDITIONAL TERMS AND CONDITIONS ARE ;STATED ON
REVERSE SIDE
•
00.
Total Amount of Sale $
Customer_Signature: X
Sales Associate: X
Approx. Start Date: Approx, Completion Date
Notice to California Residents Only:
IF THIS SALE IS IN EXCESS OF $500, "YOU THE OWNER OR TENANT -IAVE THE RIGHT
TO REQUIRE THE CONTRACTOR TO HAVE A PERFORMANCE AND PA'(MENT BOND OR
REFUNDING CONTROL."
BY SEARS, ROEBUCK & CO. CALIF.LIC.25455 WA.UC.SE- AR•SR- 6372N
NM LIC,2237 QR BLDS.REG.1081 NV LIC.5543 HI LIC.4285 AZ LIC.079952,
079951, 080304, 013509, 013511 UT LIC.22•228408.5501
Notice to Maryland Residents Only: M.H.I.c.#:121
NOTICE: ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS MUST BE
UCENSED BY THE MARYLAND HOME IMPROVEMENT COMMISSION. INQUIRIES
REGARDING A CONTRACTOR OR SUBCONTRACTOR SHOULD BE DIRECTED TO THE
HOME IMPROVEMENT COMMISSION, TELEPHONE (410) 333.6309.
Notice to New York Residents Only:
IN ADDITION TO ANY RIGHT TO REVOKE AN OFFER, YOU, THE BUYER, MAY CANCEL
THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATEOF THE. TRANSACTION:
Contractor: _� .
Address:
Telephone: r . S - 5 - fl' 6bo
Special Instructions:
x
_t•. .. •t>,
21712 -010 (Rev. 895) Sean Fame Management
TA WARF : AA REST A?. ' T n r
License o ' ` 32
1 acknowledge receipt of merchandise endror services In the total amount ;hewn hereon and agree thel this credit
purchase Is subject to my Agreement with the credit card Issuer Identified hereon, If this lea a tdlt purchase under my
SearsChergo Agreement, then I grant Sears a Security Interest in the merchandise described hr reon, unless prohIbited
by law, until paid In tun.
Purchased By
It the sale Is On Easy Payment Modernizing Credit Plan (EP /MCP). or Sears Home Imprewetttent Plan (SHIP), use
applicable Contract form.
1•Installur Copy
'flN RNIIHrl
TRtt� '1•rL4 LYV"7..'L•` `2:
1 111111111111111101111111111 11
s PC C t
!a. a .r; ?n-
EI.,AS EDE
r-: M� !
LL3!?: LL NE 53RD
L DRY : F mo
? t r ±;X Ai .i - INSTALLED ,0;)
w;
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