REOC-09-648Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: April 21, 2009
Inspector: Bruhn, Norman
Owner: CONE, GORDON
Job Address: 54 NE 97 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060130770
Building Department Comments
,3*
Passed "te
Failed
ia‘
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CALL SUSAN LAWSON AT 305 - 218 -2820 CLOSING WILL BE 4/21/09
April 20, 2009
Page 10 of 20
RE- OCCUPANCY
-AP
1Y11GL1111 011M C5 V merge
Building Department
ECEI VED
Date.
Contact Name
Buyer Seller
Property Address
City Miami Shores
Realtor
State
FL.
Loc ID
Phone
Company Name
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
1
rmit Nn.
1\10C `' 1 l:' 1
Zip 33
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 al the foregoing information is accurate.
Applicant Name 4 (LS i lAk.00
Signature
05,_02/'(f)
The foregoing instrument was acknowledged before me this 2!.) day of 4clpit 1 , 20 09 ,
by
produced as identification and who did take an oath.
NOTARY PUBLIC:
is personally known
t
•,
e or who has
Sign:
Print:
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03).
w G . ti
,i�A• 1'+3 %Cr
cesN
(\5
AioN6r° 40k-Pz/
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total
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MI SHORES VILLAGE
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