REOC-4-19-940Miami Shores Village �CEIVED
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Buildin g Department PR 2 9 201 artment �
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y;
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit No.'�" ��{{--��
o'ccH ^1 9 -9 i3
APPLICATION �Z3� �,�, �- 301 r
Contact Name: AC_L&—bL0,-a Phone#;
Buyer: �l— µl , e f '`91C Ad elier: �' ��46kc Aja 01k s r,
Realtor: Company Name:
Property Address: 12 01 NE 102— S * rep--
City: Miami Shores State: Florida Zip; .33 13 E
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
Signature:
The foregoing instrument was acknowledged before me this Z_'11
day of t
who is pers nally known to me or who has produced
rru►b i ��►�r
As id4tification an(�, ,A a a °d h
NOTARY P LIC:
Sign: `t
Print:
My Commission Expires:
Building Officials Approval:
REV 4 -10
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ea
Re -Occ $60.00
Notary $5.00
Total $
REs MIAMI SHORES VILLAGE
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Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
x1 Tel: 305 - 795 -2204 Fax: 305 - 756 -8972
Permit No. REOCC -04 -19 -940
Certificate of Re- Occupancy
Address: 1201 NE 102ND ST
City: Miami Shores
State: FL
Zip: 33138
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: