150 NE 100 St (7)Acknowledged
FILE RETURNED TO: INITIAL
Miami Shores Village
Building Department
PLEASE PRINT
DATE: TIME: 1 2. . ' d 0
NAME OF PERSON REQUESTING FILE: L- ?/e /4 C Sh 14f I {-
y
PHONE #:305 /'M3 YOUR ADDRESS: 7s0
ADDRESS OF FILE REQUESTED:
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
INFORMATION REQUESTED: Su r Ve
I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.