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REOC-4-19-808Miami Shores Village FjScEI�K"ED Building Department R 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 l' INSPECTION'S PHONE NUMBER: (305) 762.4949 ]By- RE- OCCUPANCY Permit No. &6& 4 -11 _808 APPLICATI(7N Contact Name: Z?-/' Z/ &_1 //1-i4. Phone#: XZ7 F,7%l� 1`1:� Buyer: Y 1 k=' 124 Seller: ZZ Realtor: hill '{,�1 1/r Company Name: � �' �!%' ya ,• �s„r, Property Address: /'� ` %i/+f '� /e�/ S '� City: iami Shores State: y: Florida ,Zip: I hereby certify that I understand that the zoning for this 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. APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate. Applicant Name: '�;,f,% —f- Signature: The €ore =ping instrument was ack�n�ojwlledged before me this day of } f I zo ,by IfV+1iICtM �KOi11Gin who is pers1onally known to me or who has produced f �� f ` +C `R n S�-R As identification and who did take an NOTAR PUBLI Sign:, Print: �h d+� s i.• My Cp m scion E4 Building Officials A REV 4 -10 'Y +i NGG 287268 r B fed V •'yi STA�a� Re -Occ $60.00 Notary $5.00 Total $ N °REs MIAMI SHORES VILLAGE Building Department 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 ft©RION Tel: 305 - 795 -2204 Fax: 305 - 756 -8972 Permit No. REOCC -04 -19 -808 Certificate of Re- Occupancy Address: 189 NW 101ST ST City: Miami Shores State: FL Zip: 33150 This certificate verifies that the reference property has been inspected by Miami Shores Village and has been determined to presently comply with schedule of regulations of Miami Shores Land and Development Code pertaining solely to the requirement that each one - family dwelling is used and intended to be used for a one - family dwelling purpose only; however, this certificate does not constitute any representation or warranty as to the condition of the dwelling or other structures on the premises described herein, or any aspect of such condition, and interested persons are advised and encouraged to make their own inspections of the premises in order to determine the condition thereof. Building Approval d4p 111�4