REOC-09-1948Miami Shores Village
Building Department
RE-OCCUPANCY
APPLICATION
Contact Name
NOV gimg,Tavirc
git 2 4 2008
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
)QC 1q4 •
Permit No.
Loc ID
IfB
11,
3T.Gevk R=1—e.-.1/Z-5 Phone #
Buyer Seller Realtor Company Name Kuv wr t.
Property Address 2--1? N„� q ��
City Miami Shores State Fl Zip -3 1.. ' ate
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: Icer�tify that all the foregoing information is accurate.
Applicant N. I<0 SIn`�l 60-044-6
Signature
The or goin inst ment was acknowledged before me this 94 day of
by YLL) who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
Rev. 10/02/03)
Re -Occ. $60.00
Notary $5.00 \
CCF $0.60
Total (0(
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 130090 Permit Number: REOC -11 -09 -1948
Scheduled Inspection Date: November 25, 2009
Inspector: Bruhn, Norman
Owner: WILLIAMS, MARIE
Job Address: 297 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
u000.004,
Phone Number
Parcel Number 1132060134290
Building Department Comments
Passed 4
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
PLEASE CALL BEFORE GO
JIM PETERS 305.302.4795
November 24, 2009
For Inspections please call: (305)762 -4949
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