REOC-09-1504 Miami Shores Village
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Building Department
10050 N.K2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE—OCCUPANCY Fax (305) 756 -8972
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APPLICATION l CEP 1 009 Permit No.
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Contact Name VAq j c C in 4L, 1 Phone # �?S_ — 21 (�
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Buyer l,r,o. Seller - PPfS Realtor G°wt.6- �to mpany Nam-&IfV Uhrld ►kM:kI6ruJ
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Property Address S _D' 1IJW 1 1 S e - +
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City Miami Shores State Fl Zip 33 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 Shares Village certifies only that the referenced property is
being used for single - family purposes and that such Certificate does not constitute an representation,
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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 O t, entle
Signature
The foregoing instrument was acknowledged be-for-c- me this day of 20
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by - �-�' +k , wh is personall�know�n> me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
CEMAK
WCOMMISCI # 084 1
Sign: : ' BadmmNderyPub Bat Hrra Re -Occ. $60.00
Print: Notary $5.00
My Commission Expires: CCF $0.60 ---
Total
Building Officials Approval: 1 E 1- AID
(Rev. 10102103) �✓ '�"� O`
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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: INSP 124254 Pe Number: RE -9 -09 -1504
Scheduled Inspection Date: September 14, 2009 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: , Work Classification: Re- Occupancy
Job Address: 52 NW 111 Street
Miami Shores, FL 33168 -4322 Phone Number
Parcel Number 112136003037
Project: <NONE>
Contractor:
Building Department Comments
Ys �
Inspector Comments
Passed PLEASE CALL BEFORE GO
MAYRENE MICHELI 305.827.2212
OK ALL PERMITS CLOSED
Failed :)
Correction
Needed � �'�' �
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Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Cnnfamhnr 44 gnna For Inspections please call: (305)762 -4949 pans 17 of 1a