REOC-09-1946 Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
"— OCCUPANCY Fax: (305) 756 -8972
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U� �® Loc ID
Date / — �, 3 c>� BYa -- m ®°
Contact Name AL 40 ��� Phone #
Buyer Seller Realtor i. ' Company Name /a /1, hl /114%_ -
Property Address / AZ W / / / (2�
City Miami Shores State Fl Zip 333 / s - z5
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 � ��s� h a"
Signature �.
fN
The ore oin U*strumen as acknowled ed before me this da of �20 by �g g g y by 1 �/} who i 12ersonally known to m e or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:.
.•
Sign: Re -Occ. $60.00
Print: ���p Notary $5.00
My Commission Expires: V �.e ° °r �'����� CCF $0.60
Total
Building Officials Approval:
(Rev. 10/02/03)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 130065 Permit Number: REOC -11 -09 -1946
Scheduled Inspection Date: November 25, 2009 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman
Inspection Type: Re Occupancy
Owner: ANDERSON, DAVID Work Classification: Re- Occupancy
Job Address: 469 NW 111 Terrace
Miami Shores, FL 33168 -
Phone Number (305)754 -9774
Parcel Number 112136001047
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passe PLEASE CALL BEFORE GO
ALAN BEARDSLEE 305.218.7200
Failed Of-
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re4nspection fee is paid.
November 24, 2009 For Inspections please call: (305)762 -4949 Page 16 of 24