640 NE 101 St (4)Type Insp'n
Name
Phone #
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date , 02-22 -- 62 Time
4 eiht1/414
If
Permit No. 77 P 2 --
Address (Q C -C / f) f f
Company )9 C / PG 7 00 CY 5Y..�7r
For Inspector: 2_
Approved
Correction
Re- Insp'n Fee
ez. Name & Date