REOC-09-1917 -Miami Shores Village
Building Department
10050 N E.2nd Avenue
f� E � ' I w Miami Shores, Florida 33138
A � A Tel: (305) 795 -2204
RE— OCCUPANCY 8 2009 Fax (305) 756 -8972
APPLICATION Permit IvQ.
Loc ID
Date. /( lv 0
Contact Name S, Phone # o
Buyer Seller Realtor V mpany Name
Property Address f LJ U
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City Miami Shores State Fl zip • l� .,.
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 Name 4400 C1 6n i�- y�,.,�.P,n j� 6 rruP, The .
Signature
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The foregoing instrument was acknowledged before me this day of &w—A�- 20
by - Stw s /Yo - who is personally known to m
ro 9and who did take an Oath.
NOTARY PUBLIC: 57', ®F r: - 0R1,AA
c o tiNTy or—
NOTARY PUBLIC -STATE OF FLORIDA
Sign: , ,,,., r • Lnffaine Maestre Milan Re -Occ. $60.0
Print: ®rra,ne es Y �i r Commission #D 657277
�i 1 ¢-� ` ,� Expires: MAY 0 9 , 2011 Notary $5.00
BONDED MU ATLANTIC BONDING CO., INC.
My Commission Expires: $�9�2®f/ CCF $0.60
Building Officials Approval: Total
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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- 129659 Permit Number: REOC -11 -09 -1917
Scheduled Inspection Date: November 19, 2009 Permit Type Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: , Work Classification: Re- Occupancy
Job Address: NW 110 Street
Miami Shores, FL 33168- Phone Number
Ji8rcel Number 112136003064
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL BEFORE GO
h4�7_ LORRAINE M. MILAN 305.857.5000
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 18, 2009 For Inspections please call: (305)762 -4949 Page 23 of 24