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REOC-07-19-1533Miami Shores Village Building Department 10050 N.E,21ld Avenue. Miami Shores. Florida 33138 Tel: (305) 795,2204 Tax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 RE- OCCUPANCY APPLICATION Contact. Natne: 4�0 kl_� Buyer: _ Realtor: Property aO U6 lam' chi i �l � In 7 ..,u a- Permit No. Llz� r --k-C Phone #: 7 99 1-91 937,6 Seller:: Company Name: City: Miami Shores State: Florida J �7ip: 33 I hereby certify that 1 understand that the zoning for- this property is for single- fa►nily 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 mr this d:q of 20 ? . by L � {&'r who is pet nrttrlT), known to me or who bas produced As in ification and who did take on ;ah NOT Sign: r N0 Print: �r�•• rn �i �� U� � Vy My Commission Expires:: Cx'�r� Af'�i. Building Officials Approval. {I+Et����'��s�� Re -Oce $60.00 Notary $5.00 Total $ REV 4 -10 R. {{ MIAMI SHORES VILLAGE Building Department `F 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305 - 795 -2204 Fax: 305 - 756 -8972 Permit No. REOCC -07 -19 -1533 Certificate of Re-Occupancy Address: 667 NE 105TH 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