RC08-770 Miami shores Village
Building Department
10050 N.R2nd Avenue
Miami Shores,Florida 33138
Tel:(305)795-2204
RE-OCCUPANCYr ';a Z M1 9"W,�E--*,C Fax:(305)(305)756-8972
APPLICATION ,,�R ��p� ` Permit No.
V
Loc ID
DategZa/ 01
Contact Name ii/ +u, 0 S Phone#(3 0 S 6 4,/ - a!
Buyer 6, Seller Realtor d&5odCompany Name k0111/A*S
Property Address 0 3 St
City Miami Shores State Fl Zip 3'-f/a x-
I hereby certify that I understand that the zoning of the property is for single-family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single-family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name, o�-� "/� Lw s o�
Signature
The foregoing instrument was acknowledged before me this day of '�� , 20
by Afmvey 1)o w S o- , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC: anti" t�PALMEM
:.. ,. MY comkos tONt#OD 419749
EMAES:August 18,20
Sign: Re-Occ. $60.00 ✓
Print: ^ ` et4`,.,! Notary $5.00
My Commission Expires: CCF $0.60
Total
Building Officials Approval:
10102/03)
i
Inspection Worksheet
Miami Shores Village
uu
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Now
Inspection Date: 04/29/2008 ® Permit Type: Residential Construction
Inspector: Grande, Claudio Inspection Type: Re Occupancy
Owner: SHEEHAN,WM Work Classification: Re-Occupancy
Job Address: 1181 103 Street NE
Miami Shores Village,FL Phone Number
Parcel Number 1122320310060
Project: <NONE>
Block: Lot:
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL
NANCY DOWSON 305.6942166
CC
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid
Monday,April 28,2008 Page 2 of 2