REOC-10-954(Rev. 10 /02/03)
RE- OCCUPANCY
APPLICATION
Property Address 9 On
City Miami Shores
Applicant Name
Signature
by
Sign:
Print:
My Commission Expires:
Miami Shores Village
Building Department
MAY . 2010
Date (20 l4
Contact Name t� pi e9
Buyer ezpsiljakc Seller Realtor ki AR7 LDa 'Company
111 lit> c2 n k AVV ei
State Fl Zip f SO
��— Phone # 9 J 7,7,5q173
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.
PA
The foregoing instrument was acknowledged before me this 9a y of
, who i
p ersonally known to mi or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No.R E0C 10 �
Loc ID
Re -Occ. $60.00
Notary $5.00
CCF $0.60 IN
Total C ® -03
Inspection Number: INSP- 144499 Permit Number: REOC -5 -10 -954
Scheduled Inspection Date: May 27, 2010
Inspector: Bruhn, Norman
Owner: ARROCHO, CARLOS
Job Address: 9400 NW 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Building Department Comments
'3•CD Q
Passed
Failed
Correction
Needed
Re- Inspection
Fee
May 26, 2010
S'27I
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comments
PLEASE CALL
LARRY LOUIS
305 - 725 -8637
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number (305)953 -3333
Parcel Number 1131010150290
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