61 NE 102 St (10)DATE: 0
NAME OF PERSON REQUESTING FILE: N l/ /10 lQ J7'
PHONE #:316- 7s YOUR ADDRESS: 6 / AJ / a 2 J r ,
ADDRESS OF FILE REQUESTED:
INFORMATION REQUESTED:
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:
FILE RETURNED TO: INITIAL
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, FI 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
PLEASE PRINT
TIME:
de
77‘Oz-
Miami Shores Village
Building Department
NAME OF PERSON REQUESTING FILE:
Acknowledged by:
FILE RETURNED TO: INITIAL
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
TIME:
30/7
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PHONE #: �' G� I YOUR ADDRESS: 'r �� /a 2N-g
ADDRESS OF FILE REQUESTED: 5/6)79-7,e--, "K- 0 6=P
INFORMATION REQUESTED:
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.
1 - 2 ,11 '
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MESSAGE:
FAX SHEET
DATE / / /9-2
TO: are; FAX * 7,
FROM: FAX FAX * 756 -8972
NUMBER OF PAGES:
X4 ‘
10050 N.E. SECOND AVENUE
MIAMI SHORES, FLORIDA 33138-2382
TELEPHONE (305) 758 -8000
FAX (305) 756 -8972
Accts. 411 3M.4 -49
`CANCELLATION ADVICE
Tilde. Dept. of P.Tiami Shores
r ami Shores, Fla.
Assured T "ar. c Cavali eri
By
Date fiarch 31st,
Address 165.... 5..:.7... 9. 3r. d...S- t.,....l.Tiami..,....fl, s.
Our Policy No, TIC 7 - 15243 effective October 12th,
covering the above risk has been cancelled as of 4 . #Fi --3II
(date)
:season: recalled :fork Completed
FIREMAN'S FUND INDEMNITY COMPANY
Des. of Cov: Carpentry & 116 John Street, Ney York 7, N. Y.
T, " :asonry
19
Bldg. Dept. of T:iami Shores
Shores, Fla.
CANCELLATION ADVICE
Assured I arc.e1.- .- C
Address 1.65 11..W.. 9.3r..d....S- t......Mi.ami. _ Fla.
Our Policy No. LP 7 - 2262 effective O.n.tob.ar. 12th., 19/19
covering the above risk has been cancelled as of 2 - -
(date)
Des. of Cov: Carpentry F- Masonry
FIREMAN'S FUND INDEMNITY COMPANY
116 John Stre$ ewYork 7, N. Y.
Accts. 411 3M-4-49
By
Date February 3rd,
19 50
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FIREMAN'S FUND INDEMNITY COMPANY
Date 12, 1
This is to certify to: BUJ.iid 1)72.,TA.ifiTLIETIT MAIV.LI Sil0
Address 1.11.A1AI Sli0U, FLORIDA
that the following described policies are in force at this date:
Name of Insured
liATICEL
.. .
Address 165 �Ji, I T 'AM I L01IDtt
POLICY NUMBER
IX 7-15243
LP 7-2262
222202
BS BS BS
MISC. 442$13 50M-1-49
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KIND OF INSURANCE
WORKMAN'S COMPENSATION
PUBLIC LIABILITY
Each Person $ 10 ,000
BODILY INJURY
1 Each Accident $ 20, 000
PROPERTY DAMAGE f Each Accident $ 000
1 .; rino
1 Aggregate $ -Lu
OWNER'S OR CONTRACTOR'S
PROTECTIVE LIABILITY
BODILY INJURY
PROPERTY DAMAGE
AUTOMOBILE LIABILITY
BODILY INJURY
CERTIFICATE OF INSURANCE
PROPERTY DAMAGE— Each Accident $
(MISCELLANEOUS LINES)
Description of Coverage: CAHPENTRY 1.TASOITRY
PRIOR. TO ANN Oi.A1 IN 01 OAT: DI,LAr2I T. 0 TIH POLICY 07.\ iUJ
OT IPY T CITY VIAY I SIT.0:1 , 1,71.AT!I , f7r.j13'2 ••••Ti
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EASTERN DEPARTMENT
NEW YORK
LIMITS
STATL'2011Y
J Each Person $
1 Each Accident $
J Each Accident $
'Aggregate $
J Each Person $
1 Each Accident $
TT": : :;.7".1 7 •
BS BS BS
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BS2BOBS
EFFECTIVE
AT
12 49
10
10/12/49
EXPIRATION
1dM
10/12/50
Authorized Representative
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