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REOC-09-1944Miami Shores Village Building Department MM(oF_EWMif ig NOV 2 2009 lb BY e® me mme Loc ID RE- OCCUPANCY Date V\ 121\41 © i Contact Name 141 100% -tN.,1 - Arice(�l Phone # 'T) O & O oc3Buyer Seller Realtor Company Name C,l0 l Ct t.4 10050 N.E.2nd Avenue Miami Shores, Florida33138 Tel: (305) 795 -2204 Fax: (305) X56 -8972 Property Address 35B ci a 9 S� City Miami Shores State Fl Zip 1395 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 i�lr(ti\ rk Q \(\c\cApz,y Signature The for oing'nstru nt was acknowledged before me this a4- day of bye -IT �i produced Sign: Print: My Commission Expires: who is personally known to me or who has 12: oGO 1as identification and who did take an oath. NOTARY PUBLIC: 1' 30� vsk Building Officials Approval: (Rev. 10/02/03) Re -Occ. $60.00 Notary $5.00 CCF $0.60 Total REG C07 112409 0942 liC#01 06126 CASH $65.00 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 130052 Permit Number: REOC -11 -09 -1944 Scheduled Inspection Date: November 25, 2009 Inspector: Bruhn, Norman Owner: PERALTA, VICTOR Job Address: 358 NE 94 Street Project: Contractor: Miami Shores, FL <NONE> Permit Type: Re- Occupancy Inspection Type: Re Occupancy Work Classification: Re- Occupancy Phone Number Parcel Number 1132060136150 Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments PLEASE CALL BEFORE GO KIMBERLY OMAHONY 305.970.6000 November 24, 2009 For Inspections please call: (305)762 -4949 Page 14 of 24