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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