278 NE 97 St (12)(Rev. 1 0/02/03)
RE- OCCUPANCY
A- PPLICATION
Date // 0 2-00 (0
Contact Name 6r,8 P J ) (Qv
Buyer 3 re'r / Seller lilt . Realtor Lqrey
Property Address P It /: 9 7 Fk S f
City f� Miami Shores ^ State Fl
La vv )/ lag ; S bit yevS II eQ' )t 6 %6) /14; (j :
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name
Signature
produced
AR ' 4UB el' 1 41\
Com iss v; 200
Sign:
Print:
My Com
ission xpircs:
Miami Shores Village
Building Department
(.2r It (or
it No
Loc ID
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Zffni2- btO
Company Name Caj.P r� e�( �Y
seBllY a. ,44 seL11As re
Phone #
Zip ..'3/ 3P
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.
The oregoing ins ent was acknowledged before me this day of , 20 Cr() ,
by ( ;{nett V Q tlll ,6ho is personally known to me or who has
as identification and who did take an oath.
Re -Occ. $60.0
Notary $5.00
CCF $0.60
Total
i ( 7 °
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP -33645
Permit Numbe RC -11 -06 -2880
Inspection Date: 12/04/2006
Inspector: Grande, Claudio
Owner: MILLER, GREGORY & KELLY
Job Address: 278 97 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor:
Building Deuartment Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
]ECC 05Er
Block:
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Re- Occupancy
Phone Number 954/817 -3349
Parcel Number 1132060133990
Lot:
Thursday, November 30, 2006
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