RC-07-2516Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Date: 12/26/2007
Inspector: Grande, Claudio
Owner: RYAN, ELIZABETH
Job Address: 759 94 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
010..1° Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060142020
Block:
Lot:
Building Department Comments
.4
4
-
/
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, December 20, 2007
Page 2 of 2
ivii irll 1311 r CS d mage
Building Department
RE- OCCUPANCY
APPLICATION
Date
DEC 2 7007 1
BY:
Contact Name R-pt,
Buyer Seller altor
Property Address S 191 TO 2---.{
City Miami Shores State Fl
1
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. r) --25to
Loc ID
Pho„ ;sos�,6 -8486
Company Name
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 N
S ignature ,
The foreg.11'ng ' rumen�t was acknowledged before me this day of
by �,0 ' � f' ufir 7CJ , who is personally known to me or who has
produced D �F1 1 -d 10- 3f"00Q% as identification and who did take an oath.
NOTARY PUBLI :
2007
Sign:
Print:
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03)
4'
Re -Occ. $60.00►
Notary $5.00 NI
CCF $0.60 N
Total
S