REOC-09-1478 Inspection Worksheet
Miami Shores Village
10050 -.N.E. 2nd Avenue Miami Shores, FL
Phone: (306)795 -2204 Fax: (305)756 -8972
I nspection Number: INSP- 123646 permit Number: REOC -9 -09 -1478
Inspection Date: September 03, 2009 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: DUKES, KATIE Work Classification: Re- Occupancy
Job Address: 166 NW 96 Street
Miami Shores, FL Phone Number
Parcel Number 1131010240190
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed
Fail
ed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4848
September 03, 2009 Page 1 of 1
Miami Shores Village
` ` Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE- OCCUPANCY nn `1
Fax (3 756 -8972
A P T Permit No" EnC _ — Qq —114 B
Loc ID //.3 / , q /0 24
Date a t 1 3 D
Contact Name Gk � ! F�—��
Buyer Seller f vS CF'c,� Phone # 3�,� ( 3 e
A V IV - 0, tX LVca
'��e Realtorl�, Company Name e(je, Wt ♦•��M,q
Property Address ( C„ ��w R� S *_ (Ilea
City Miami Shores State Fl Zip 3 2 1�F d
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 Nam a t � c,p
Signature 21,
6
//
dl
The foregoing instrument was acknowledged before me this day of S rnl/" �
20 D`"I
by Au gull-OM. 1 t, l o p , who is personally known tome or who has
produced /<& /,9—o/3 — S/ - 5_69 - 0 as identification and who did take an oath.
NOTARY PUBLIC:
Sign: ° O Re -Occ. $60.00
s
Print: Ir`'f Notary $5.00
My Commission Expires: °"Q ,��,�c CCF $0.
Total
Building Officials Approval:
(Rev. 10102/03)