REOC-09-385Inspocton VVc et
Miami Shores ',.•;:TLI1e
1Qt5 N.E. 2nd Avenue 0Tho�s,
Ph ne: (306)796-2204 • C'AF11756:6972
Scheduled Inspection Date: March 13, 200
Inspector: Bruhn, Norman
Owner:
Job Address: 1077 NE 96 Street
Miami Shores, FL. 3313E-
Project: <NONE>
Contractor:
20021991P
• • • • •
• 1 • •.•
Permit Type: Re-Occupancy
hispection Type: Re O;upancy
VVork Ftie-OG:,:;upancy
Building Department Comments
•,- -a- `, - •
-afC LflEr 132i,60143680
10300700=100/00000070,00100,00,,, ,404700, 010E000 00:0000 010100,0 ,7,0000 000.00
Passed
Failed
Inspector Comment;
Please call hi:for€ go
n 305.218.7200
Correction
Needed
Re-Inspection
Fee
No Additioria Inspections can be scheduled until
re-inspection fee is paid.
March 12, 2009
1
Poge 14 of 19
RE-OCCUPANCY
APPLICATION
3 //a /Or
Date
Contact Name
Buyer Seller
Property Address / 7 Ad/
Miami Shores Village
Building Department
1tt-e7--
U
Rea
palEgVICI
MAR 12 2009
BY eo...`'�—
.10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. -'
LocTD
Phone #3 5 I 70o
Company Name A�`ipj�- j r,>)%lielo . S
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.
Applicant Name I l Wl() t-
ill Y 1140/1
Signature Gam,\
The foregoing instrume r was ac(cnowledged before me this I9
6- A
by 11
day of dbyrk,,, 2009 ,
who is personally known to me or who has
produced' 1 . jS ; -0109.0 -��p as iq@ntification and who did take an oath.
NOTARY PUBLI : �° ti�
Sign:
Print:
My Commission Expires:
Building Officials Approval:
Rev. 10 /02/03)
Re -Occ. $60.00
Notary $5.00
CCF $0.60\
Total (oS • (00