REOC-10-10751
Scheduled Inspection Date: June 15, 2010
Inspector: Bruhn, Norman
Owner: LANE, CULLEN
Job Address: 103 NW 103 Street
Project: <NONE>
Contractor:
Building Department Comments
June 14, 2010
Miami Shores, FL 33150-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 146010 Permit Number: REOC -6 -10 -1075
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number 305 - 539 -2495
Parcel Number 1121360131580
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Please call Patrick Duffy
305 - 343 -1212
C Y
Page 21 of 25
0'
Rev. 10/02/03)
RE- OCCUPANCY
APPLICATION
Date 1
Contact Name t vE �� Phone # 422 34 -t ��-2-
Buyer Seller Realtor Company Name
Property Address
OWNER'S
�H+as4�
Applicant Name
Signature
0
Miami Shores Village
Building Department
ANJ
City Miami Shores State Fl
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.
Building Officials Approval:
certify that all the foregoing information is accurate.
E st Lo -4 -
.10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756-8972
Permit No. 1 6
• • Loc ID
Zip (• S -0
The foregoing instrument was acknowledged before me this ( - day of J U. , 20) C
by ai i t \ )4- , who is personally known to me or who has .
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign: L-Li E . Re -Occ. $60.00
Print: L rmS E L.. i - - Nota $5.00
LOIS E LINDLEY _
My Commission Expires: ' ''' ;' MY COMMISSION # D0838034
EXPIRES December 15, 2012
40? -60.0995 PlondeNoterySennce.com Total