RO05-229v 2005
MIA O S VILLAGE
C BUILDING DEPARTMENT
- - , 305- 795 -2204
Building Inspection Request
Date C)6
Type Insp'n E — OC L ,' U `-
Permit No. PIT 0 - 229
NameT4 P-COD 1 P-1-t -- C A Sfl LL'
Address 'I' F' [ ST
Company 0 tee-i k2
Phone ( l75 Q 5 z% K&5Yi 44 74'
Inspection Date < 1 10 O5
Approved 5V/ i
Correction
❑ /
Re-Insp'n Fee ❑
Rev. 10/02/03)
RE- OCCUPANCY
APPLICATION ` - -_ - rmit No. R:(1) ZW6 - 2251
_ Loc ID
Date ji gr2COS
^' I 6"1 S29 (0
Contact Name ed() S T k- �i
- el Cash 1k Phone # 3t5 - gel -- L LflL .
Applicant Na
nature
Sign:
Print:
My Commission Expires:
Miami Shores Village
Building Department
MUNE
NOV 0 9 JI it 5
Buyer Seller �V Realtor Company Name
Property Address (OS (U • q/ S
City Miami Shores State Fl Zip 33 l 3E5 -
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.
m'il) o U a
The foregoing instrument
by 67 6) b V , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
PAMELA DEIVA
,,,,,,,, '''''
An An. An- An-
4 Pfh Notary Public - Stole of Florida
• VNyCann>bdoneciesSep28, 2008
Commission a DD : 57
Bonded by National Notary Assn.
Att
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Re -Occ. $60.00 /
Notary $5.00
CCF $0.60
Total (2O (2p
2_4E39
NOV 0 9 PAID