RC-08-252ivildiiii ►JrlUreS V triage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
ate; "`, ���� Tel: (305) 795 -2204
RE- OCCCJPANCY b!., EB 1�0 Fax: ( )
Fax. 305 756-8972
A-P- P L I -GA 11 I Permit_No PC-1_a- .2f2,--
BY.
Loc ID
Date a' -
Contact Name �, / %S ()\' Phone # 1216 9 y,2- -al/0
/. U(v�e i��
r,� Realtor Company Name Buyer Seller wCL
Property Address /?/o '7y F6
City Miami Shores State Fl Zip
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
Signature
The for oing instrument was acknowledged before me this 10 day of
4
a
by l Set/1 , who is personally known to me or who has
produced 05 2-0 i 02-- ) 2-c2 0l0 as identification and who did tak6 an oath.
NOTARY PUBLI :
Sign:
Print:
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03)
Re -Occ. $60.00
Notary $5.00\
CCF $0.60
Total __(c&G-0
Inspection Date: 02/12/2008
Inspector: Grande, Claudio
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Owner: CURRLIN, CARLOS & GLORIA
,Job Address: 1210 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor:
Nunber
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re-Occupancy
Block:
Phone Number
Parcel Number 1132060143950
Lot:
Building Department Comments
Tuesday, February 12, 2008
Page 1 of 2
i jiiil?(!3
Passed
/
Inspector Comments
CC
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Tuesday, February 12, 2008
Page 1 of 2