REOC-10-650 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 140836 Permit Number: REOC -4 -10 -650
Scheduled Inspection Date: April 20, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: BEA7TY, PRISCILLA Work Classification: Re- Occupancy
Job Address: 441 GRAND CONCOURSE
Miami Shores, FL Phone Number
Parcel Number 113206017031
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed �-
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 19, 2010 For Inspections please call: (305)762 -4949 Page 23 of 28
i
Miami Shores Village 1 APR 1 9 0
Building Department
.10050 PJ E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE — OCCUPANCY Fax: (305) 756 -8972
]PLICATION : Permit No. F-0c I
L0c ID
Date
Contact Name 1 yK Phone '# 3q �5
Buyer Seller Realtor Company Name KfLi
Properly Address (�2 i -, C—or 0— ery e-.•
City Miami Shores State Fl Zip 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:
OWNER'S AFFIDA I certify that all the foregoing information is accurate.
Applie Name j , VV\, �
Signature
The foregoing instrument was acknowledged before me this 14 1 l day of L 20
by _ , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC: `\\ \1111nu1,,,,
! penis
Sign: = s °� = Re -Occ. $60.00
Print: = U °mmi,, Nile. Notary $5.00
My Commission Expires: '•,,<" ®....... � .�`� CCF $0.6 �
Total
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e W1
Building Officials Approval:
:ev. 10/02103)