REOC-09-1736 M 200
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R&OC
APPLI
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Contact Name: M A-4-k cli r — rime . BPS -S Z_
.auyer 61 IVo -A;zdp.Sell r yr eta R;ealtor X144 k C orby Name, CAee AW % S
Perty A.iidress<
City I I hofts state E1 33
L hereby certify that i uridera that the Z.0' of - the property: is. for single- rnily ,res rlcntial ugo and
that it is unla�l: °fi r more: than nne fa ly to.reside therein, 1.*
aso uz�ders l th�tt.aoy' C:erti eat r� e-
Occupancy tai may be issued by: 1 ami sh ores 'Village certifies: only`thnt , tl a .refere�xc property in s
berg used :for sine = family purposes anti: that.... such ert f ca} .ttdos fat. cnt� e a y �repr enta 014:
warranty or rertifiration as tu ate: condition of he.dwellingor otho stmoturos cat he, properly,
()W R'$ "FWAYM. loetOk hank all the ' - fdrogoingAd , ormation is accurate:.
o ,
Applicant N
1 �l L
gna ...
The -fdre ciing-ihst- himent Was anknowledged be ore me this- day.
�u o is 1 ally . � vaho. has
V , . Y erson known tome or
:.
produced Q�/5 L. i C �..Vn Sf as.1dentificetion. d sAo-,.did tike an, oath.
I NARY PTJBUC: a LAURA HOLLOWAY
NOTARY PUBW
• STATE OF FLORIDA
Si nk
Comm# 000927089
10 Phus 912212013
Print: 4 Otto Notes MOOL „
Nay Commission F,xpires : 9/Z 2 l Zed ? CCF
'total —��
Building O1 (,Ws.*Wvd.
OCT 2
Inspection Worksheet
` Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 127489 Permit Number: REOC -10 -09 -1736
Scheduled Inspection Date: October 22, 2009 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman
Inspection Type: Re Occupancy
Owner: Work Classification: Re- Occupancy
Job Address: 122 NW 110 Street
Miami Shores, FL 33168 -4321 Phone Number
Parcel Number 1121360030100
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL BEFORE GO
MATTHEWW KRAC 786.488.5722
954.601.7301
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re4nspection fee is paid.
October 21, 2009 For Inspections please call: (305)762 -4949 Page 27 of 34