1401 NE 101 St (4)Miami Shores Village
Building Department
NAME OF PERSON REQUESTING FILE:
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
DATE: 7 /1 g V V TIME:
PHONE #: 790 YOUR ADDRESS: /0/ /
ADDRESS OF FILE REQUESTED:
INFORMATION REQUESTED:
5.,/1/.6 a
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.
Acknowledged by: C O C-
FILE RETURNED TO: INITIAL