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REOC-09-2109
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I nspection Number: INSP -1 32196 Permit Number: REOC -12 -09 -2109 Inspection Date: December 28, 2009 Permit Type: Re- Occupancy Inspector: Bruhn, Norman Inspection Type: Re Occupancy Owner: KAWALEK, JOSEPH Work Classification: Re- Occupancy Job Address: 33 NW 93 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010340280 Project: <NONE> Contractor: Building Department Comments Inspector Comments Passed ;1 4 IF Failed El Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 December 28, 2009 Page 1 of 1 Miami Shores Village ` R E C I %VJ- EE � Building Department L DEC 2 8 2009 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 RE- OCCUPANCY Fax: (305) 756 -8972 A PPLICA T-I�►N pP rm�t Nn ®R lo Date T r 72-40 Contact Name �G� / Phone # � t- L / f Buyer Seller Realtor k !e � Company Name &JItf- y Property Address Aj iJ --�— City Miami Shores State Fl 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 d - xe Signature d; - �- The foregoing instrument was acknowledged before me this day of , 20 (f , by `' r 1� --� is personally known to me or who has produced CA_ as identification and who did take an oath. NOTARY PUBLIC: \\\o "'aIII... , •,�ae�..! ....., Sign: = �:� • © Re - cc. $60.00 eO Print: Notary $5.00 My Commission Expires: S P����.�` CCF $0.60 '�u►n, n n n��� Total fX) Building Officials Approval: (Rev. 10 /02 /03)