RC-07-446Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 03/08/2007
Inspector: Grande, Claudio
Owner: ARRASCAETA, GRACE
Job Address: 127 97 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number
Parcel Number 1132060132460
Lot:
Building Department Comments
RE -OCC
MAR 0 9 200?
Passed ,14
i-lfr.„7/i
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Wednesday, March 7, 2007
Page 2 of 2
Miami Shores Village
Building Department
RE- OCCUPANCY
APPLICATION
Date / r 4 2—(2°%
Contact Name 49bYLI f
Company Name eeU&2- 1.4)/ // 723‘44_5
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. RC.--4 4-7
LocID
Buyer Seller Realtor
Property Address `21 / v� (% 3i (e `"
City Miami Shores State Fl Zip
Phone # 3os 6 W.S-31&-
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 )L 7 E
(-\
The foregoing instrument was acknowledged before me this 11 day of /? ,
y
by 1i lObivit cwhois personall own to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Signature
Sign:
Print:
My Commission Expires:
1q1 Y "`a4, MONICA LISSEm DIAZ
=* *= MY COMMISSION # DD 483995
`•�. EXPIRES:O
�`� October
I.. erwriters
Building Officials Approval:
Rev. 10/02/03)
Re -Occ. $60.00
Notary $5.00
CCF $0.60 (/
Total ‘5:
,CKZ-1-36