REOC-10-7Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 132498 Permit Number: REOC- 1 -10 -7
Scheduled Inspection Date: January 05, 2010
Inspector: Bruhn, Norman
Owner: PRICE, ELIZABETH
Job Address: 1000 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060143560
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 BEFORER GO
JIM PETERS 3053024795
L
January 04, 2010
For Inspections please call: (305)762 -4949
Page 24 of 26
Miami Shores Village
Building Department
RE- OCCUPANCY
APPLICATION
Date J
J7 P - z �.
Contact Name
Buyer Seller Realtor Company Name K iv A9,--,,,,y Property Address /CV) Nom— q (a —
City Miami Shores State Fl
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
!� Fax: (305) 756 -8972
Permit No. g F1
Loc ID •
Phone #. 36C-3 62_ .z9-51%-----
Zip 33 /38
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 ofRe-
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.
Appli 1 `"�e� s'
Signature `- -
The foregoing instrument was acknowledged before me this day of
by , who is personally known to me or who has
produced as identification and who did take an oath.
, 20 ,
NOTARY PUBLIC:
Sign: Re -Occ. $60.00
Print: Notary $5.00
My Corniriission Expires: CCF $0.60
Total•
Building Officials Approval:
k.EG x.07 010610 1451 MC :01 062314. CHECK $65.00
Rev. 10/02/03)