RC07-551 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Date: 03/22/2007 Permit Type: Residential Construction
Inspector: Grande,Claudio Inspection Type: Re Occupancy
Owner: WING, COLLEEN Work Classification: Re-Occupancy
Job Address: 1200 103 Street NE CL
Miami Shores Village, FL Phone Number 305-754-6024
Parcel Number 1132060340290
Project: <NONE>
Block: Lot:
Contractor:
Building Department Comments
RE OCC COLLEEN WING
MAR 2 3 2001
Inspector Comments
Passed
Failed
Correction
Needed
Re-inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid
Wednesday, March 21, 2007 Page 2 of 2
Miami Shores Village
Building Department
10050 N.K2nd Avenue
.�� D Miami Shores,Florida 33138
Tel:(305)795-2204
RE-OCCUPANCY MAR ZOO? Fax:(305)756-8972
APPLICATION Permit No-'BLI I U 5 I
Loc m
Date
p^� Ce,-k- I
Contact Name l..O Li.�E h C� �'` Phone# 3aa•�9 t- c. �.y
BuyerCsew,,.E Seller Cakwa Realtor n�k �� + Company Name �Lr- W)LL1a0,t
Property Address
City N iami Shores State Fl Zip
I
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
T
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.
8
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name_, '
Signature C v L L eC M 01-1 F r h),.
The foregoing instrument was acknowledged before me this day of e ,20
by A CO(k& CteTak , who is personally known to me or who has
produced !->,V UC as identification and who did take an oath.
NOTARY PUBLIC:
AVD g83995
Sign: DD Re-Occ. $60.00 .
Print: Ak Notary $5.00
My Commission Expires: CCF $0.60
Total 6`; ►�p {
Building Officials Approval:
(Rev.10/02/03) 2 .1
? �� q J
Invoice
Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Bill To
COLLEEN WING Invoice Number: RC-3-07-27905
1200 NE 103 ST Invoice Date: March 21, 2007
MIAMI SHORES, FL 33138-2002 Permit Number: RC-3-07-551
Returnto:
Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores, FL 33138-0000
Date Fee Name Fee Type Fee Amount
03/21/2007 Re-Occupancy Fee Fixed $60.00
03/21/2007 Notary Fee Fixed $5.00
03/21/2007 Re-Occupancy CCF Fee Fixed $0.60
Total Fees Due: $65.60
Payments
Date Pay Type Check Number Amount Paid Change
03/21/2007 Check 693 $65.60 $0.00
Total Paid: $65.60
Total Due: $0.00
Wednesday, March 21, 2007