REOC-10-580 T
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Numbe I NSP- 139906 Permit Number: REOC -4 -10 -580
Scheduled Inspection Date: April 07 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: FOX, LUCIUS & EVELYN Work Classification: Re- Occupancy
Job Address: 575 NE 105 Street
Miami Shores, FL 33138 -2044
Phone Number
Parcel Number 1122310140300
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passe call before go
• OMAR VILLANUEVA 305.469.5951
C�
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 06, 2010 For Inspections please call: (305)762 -4949 Page 16 of 16
Miami Shores Village g
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: .
........ ..............
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit Nog ° F�
1 _t
APPLICATION , l!v
Contact Name: 0A2 Phone # 3_ -S ) YC S
Buyer: C),, a y4 1(A, k(A (2v,4 Seller: I F"-,.
Realtor: �, l Q, , Company Name:
Property Address: :5 wit ),-
City: Miami Shores State: Florida Zip: 3 3 l3 m
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.
Applicant Name:
Signature:
The foregoing i u ent was ac owledged 01 W
f e this
day of 20 /o , byu�
who 's personally known to me or who has produced
Al 10 '� 1l As identificat n and who did take an oath
NO L cH��
Sign:
Print: tm I
� ' D1 . IXG�;a
My Commission Expires: $off ➢ � ➢ � �
Building Officials Approval:
Re -Occ $60.00
Notary $5
Total $ (6
REV 4 -10