REOC-10-1152♦ P Miami • Shores Village pamgw3iii
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RE- OCCUPANCY
APPLICATION
Contact Name: ..' c
Buyer: / V2 'VIA-) c7 J a.
Realtor: v:‘) Cc,
Property Address: I ° 9 ??
City: Miami Shores State:
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
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.
Sign:
Print:
My Commission Expires:
REV 4-10
Permit No.
e c k Phone#: ZYC 35/ 3 9 2_
1Tt . c Seller: )11, ,° L
Company Name:
Florida Zip: 3 ?ii
Applicant N /4'2 ,,) 9)) SI 2,...„)
Signature:
The fore oing strumee a s acknowledged before me this
day ofA in ,- 201N by��'U/
who is personally known to me or who has pro , ,
As identification a dk t nsath''..
NOTARY PUB ` ���� @ �� . � \ Q S.
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Building Officials Approval:
BY:
Re-Occ $60.00
Notary $5.00
Total $ Ci2F -C
Inspection Number: INSP- 146757 Permit Number: REOC -6 -10 -1152
Scheduled Inspection Date: June 24, 2010
Inspector: Bruhn, Norman
Owner: HOCH, RYAN
Job Address: 142 NW 98 Street
Project: <NONE>
Contractor:
Building Department Comments
RE- OCCUPANCY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
June 23, 2010
Miami Shores, FL 33150-
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comments
DARREN BECK
786- 351 -8342
CG
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1131010260060
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