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RC-07-550Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 sped Inspection -Date: 03 /22/2007 __ Inspector:- Inspector,_Default Owner: DOLL, ANN Job Address,_ -100 95 Street NE Miami Shores Village, FL Project: <NONE> Contractor: t Permit Type: Residential Construction Inspection Type: Re Occupancy Work Classification: Re- Occupancy Block: Phone Number Parcel Number 1132060132860 Lot: Building Department Comments RE OCC JOHN DOLL PEAR 2 3 2007 72 Passed y Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Wednesday, March 21, 2007 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 RE— OCCUPANCY ll T \ ^ Fax: (305) 756 -8972 APPLICATION ' MAR 2 1 2007 I Permit No. �_ 15a) Loc ID Date 31=1-0167 B Y: .................... - Contact Name OA I S–k\t\ —t v� �c� ` Phone # ct -1 ci `Z `i -7 Buyer Seller Realtor — Company Name 'Ke 1 k-r LLD \ Uib& vas Property Address 1 c0 9S Sr City Miami Shores State Fl Zip 3 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. (/ ►© L L Applicant Name Signature The foregoing instrument was acknowledged before me this Zl day of Ar(4 , 20 O7a by X 1i t 'Ev I1(C'S`r dog o , who is personally known to me or who has produced f S as identif .- and who did take an oath. Sign: Print: My Commission Expires: NOTARY PUBLIC: Building Officials Approval: Rev. 10/02/03) Re -Occ. $60.00 Notary $5.00 CCF $0.60 Total