REOC-10-1185I 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.
Miami Shores Village
RMaKVISI
E, JUN 2 8 2010
Building Department
v. 10/02/03)
RE- OCCTJPANCY
APPLICATION Permit No.
Date 04, i to Lac
Contact Name VIA }�-'�( =_ Phone .# ✓O' 30 z S-
Buyer Seller Realtor Company Name (4
Property Address I l SD I•i� 1 0 0
City Miami Shores State Fl
Sign:
Applicant Name
Signatur j�• /%'
The foregoing instrument was acknowledged before me this
by
produced as identification and who did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expires:
Building Officials Approval:
, who is personally known to me or who has
BY: •
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
10 InT
31
day of Q , 20 O
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total
RE -OCC
Passe 16":-)/16
Inspector Comments
jim peters 305.302.4795
,,,,
ry
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
I nspection Number: INSP- 147098
Permit Number: REOC -6 -10 -1185
Inspection Date: June 29, 2010
Inspector: Bruhn, Norman
Owner: BTESH, JOSE
Job Address: 1180 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132050190390
June 28, 2010
For Inspections please call: (305)762 - 4949
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