125 NE 94 St (8)NAME OF COMPANY OR CORPORATION
NAME OF OWNER
NATURE OF BUSINESS
FINANCIAL REFERENCES:
APPLICATION FOR OCCUPATIONAL LICENSE
BUILDING DEPARTMENT
MIAMI SHORES VILLAGE
MIAMI 38, FLORIDA
NAMES AND NUMBERS EMPLOYEES ( MASTERS AND JOURNEYMEN):
LICENSE NUMBER OTHER MUNICIPALITIES:
NAME AND AMOUNTS INSURANCE CARRIED
(SIGNED) .
DATE)
ADDRESS_ _ PHONE
TSTREET NUMBER OR P.0: (CITY)
PHONE
( If a firm, the nams of all members of the firm; if a corporation
the namee. of all officers cf the corporation)
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NOTARY PUBLIC - STATE OF FLORIDA
My Comitssion Expire 's__
(OWNER)
Read. Sworn to and Subscribed Be = f:' r e me
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