REOC-10-1153RE- OCCUPANCY Permit No. “a —' .Q—' 11 S 3
APPLICATION
Contact Name: N c _.fi (-.: ,,Z. Phone#: — J SO%
Buyer: L \-Pt $ �J �6 Seller: �,� - r�lc L_ L �
Realtor: 7" P G Z. Company Name: 1�k
Property Address: S C 0;) \ V ST .
City: Miami Shores State: Florida Zip:
I hereby certify that I understand that the zoning for this 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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name:
Signature:
The foregoing instrument was • :. oo • ged efore me this
day of _, 20 ,Q,+ - by . F-(N (dfNr
who is personally known to me or who has producO i i 9 p
As identification and *did taW�,q,
NOTARY P LIC: . , 0 ,./ f�'o
Sign: ' '.. ® ,� a
Print: . /A i'�� ® ��
My Commission Expires: % O � ` ' ' `�O /�';
'''''114 °41 t .i t -D ;;I A. I . i . i . ‘ . ° N‘
Building Officials Approval:
REV 4-10
Miami Shores Village o zany
Building Department JUN ; 3 2 i t:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BY: ..
Re -Occ $60.00
Notary $5.00
Total $ C.
Inspection Number: INSP- 146782 Permit Number: REOC -6 -10 -1153
Scheduled Inspection Date: June 24, 2010
Inspector: Bruhn, Norman
Owner: LEE, PATRICK
Job Address: 560 NE 95 Street
Project: <NONE>
Contractor:
Miami Shores, FL 33138-
Building Department Comments
June 23, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number (305)757 -0468
Parcel Number 1132060140800
RE- OCCUPANCY
to ( J- 06
o •.
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
JAVIER GONZALEZ
305 - 582 -5085
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