573 NE 102 St (2)KATHRYN PAULK
CELL (305) -495 -2745
PHONE (3050 754 -4282
/
Passed
G
1
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
'Inspection Number: INSP-5333
Inspection Date: 01/09/2006
Inspector: Grande, Claudio
Owner: KLIMKEVICH, NATALIE
Job Address: 573 102 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor:
Building Department Comments
Friday, January 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
LO
Block:
Permit Number: RC -1 -06-45
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060171000
Lot:
Page 2 of 2
RE- OCCUPANCY
AP--P--L-ICAT-ION
Dat l �Dc
Signature
Miami Shores Village
Building Department
P ctu
Contact Name
Buyer Seller Realtor
Property Address
JAW 0 -
City Miami Shores State Fl
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name 14- U 1
Tres: SEP. 27, 2009
NOTARY Pt113LIC- M`AI'D OF FLORIDA
Yorleny Hernandez
Sign:
Print:
My Co mission Expires:
Building Officials Approval:
(Rev. 10/02/03)
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756-8972
-- Fer_mit_No.._ R C " 7o6'7
S
Loc ID
P ( 05 7 £ 5
Phone# 305 7S `f2
Company Name
Zip
Co 1c� �1
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.
The foregoing instrument was acknowledged before me this .o. day of N , 20 06 ,
b KI +igy ) I P•AG4 -Jiho is personally known to me or who has
produced 1 b . as identification and who did take an oath.
NOTARY PUBLIC:
Re -Occ. $60.00 /
Notary $5.00
CCF $0.60
&s. 60.
Total
JAN 0 6 PAID