REOC-10-488 I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 138848 Permit Number: REOC -3- 10-488
Scheduled Inspection Date: March 25, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: PICHARDO, PABLO AND LUZ Work Classification: Re- Occupancy
Job Address: 101 NW 101 Street
Miami Shores, FL
Phone Number (786)251 -0641
Parcel Number 113101022014
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL
BRIGETTE BIENVENU
`-� 504- 352 -5112
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 24, 2010 For Inspections please call: (305)762 -4949 Page 13 of 21
Miami Shores Village
Building Department
10050 NEW Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
— OCCUPANCY Fax: (345) 756 -8972
APPLICATION Permit No. 0 kQ ( - t 0
DY. Loc ID
Dates _
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Contact Nam e; �- & �V t l t - _ W ( V Phone #
Buyer Seller Realtor Company Name
Property Address leo1 ST
City Miami Shores State Fl Zip
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
i
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 Name � u U
I
t
Signat
The foregoing instrument was acknowledged before me this )A day of �� � C h , 20 �, f
by �.'H ' -e C * �ho is personally known to me or who has
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produced as identification and who did take an oath.
NOTARY PUBLIC:
e
Sign: Re -Occ. $60.00
Print: e Notary $5.00 j
My Commission Expires: CCF $0.60
Total Cb
Building Officials Approval:
(Rev. 10/02103)
Notary Public State of Florida
r Arlene Leal Morejon
c My Commission DD797693
®sst°� Expires 08/1312012