1069 NE 91 Terr (8)Date /
Type Insp'n 0161 111111P' M
Permit No. T 2 o03 - 11 0
Name _
Address 06 b 1 1 • q
Compa
Phone #
For Inspector ) jime & Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTM
305- 795 -2204
Building Inspection Request
Time
Date
Type Insp'n
Permit No.
Name
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Approved
Correction
Re- Insp'n Fee
Address
Company
Phone #
For Inspector:
b =
ame & Date
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APPLICATION FOR
CERTIFICATE OF RE- OCCUPANCY
I , \ \\ ek i 1 1 AYY1(1 apply fcr a certificate to re-cc py the single-
family residence known as 100
, Miami Shores. Ronda.
ailda Lot Block , Plat , as a single -family residence.
I hereby certify that l understand that the zoning of the property is for single-family
residential use and that it is unlawft.d for more than one family to reside therein_ ' I also
understand that any Certificate of Re-Occupancy that may be issued by Miami Shores
Vilage, Florida, 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 = • — property.
Date:
For purposes of conducting the inspection required by Section 902 of the Miami
Shores Land Develo • ment d Zoning Code, please contact the following p - • n(s):
Faded ( ) because:
Page 1 of 2
onship:
A40ca1ion Received: 10_ GI-4Q a 1- -(oyit r e
Name:
Phone No.: 7c 0/R") a1. Address-
- Application Fee ($50) Paid: Check No. j / L/ 7
Inspection Made: 8 Y
Inspection: Passed orr 1' P(4)4c)
CERTIFICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned cedes - that the
property described in the above application has been inspected for purposes of re-
occupancy pursuant to Sermons 901 and 902 af the Miami Shores Land Development and
Zoning Cade and that such property may be re-occupied by the above applicant for single -
family residential purposes.
Page 2 af 2
MIAMI SHORES VILLAGE. FLORIDA
44\
Date: ofc [3h7 � 9V
THIS CERTIFICATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF
THE MIAMI SHORES LAND AND DEVELOPMENT COOS
PERTAINING SCLE_Y TO THE REQUREMENTTHAT EACH
ONE - FAMILY OWELUNG IS USED AND INTENDED TO BE
USED FOR A ONE- FAMILY DWELUNG PURPOSE ONLY;
HOB THIS CERTIFICATE DOES NOT CONSTITUTE
ANY REPRESENTATION OR WARRANTY AS TO THE
CONDmON OF THE DWELLING OR OTHER STRUCTURES
UCTURES
CN THE PREMISES DESCRIBED HEREIN OR ANY
ASPECT OF SUCH CONDITION, AND INTERESTED
PERSONS ARE ADVISED AND ENCOURAGED TO MAKE
THER OWN INSPECTION OF ME PREMISES IN ORDER
TO DETERMINE THE CONDITION THEREOF.
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