REOC-05-19-1241RE- OCCUPANCY
APPLICA'T'ION
Miami Shores Village
Building Department
10050 N.L'•.2nd Avenue. Miami Shores. Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
EIVED
MAY 0 19
5y:
Permit NoO
Contact Name: O t4— u- r ^e Pltolte #: - (o 2F, l 3-7 �o
Buyer: 1-S Seller:i
Realtor:f L-�� Company Name:
Property Address: c?_710 \ QE LA4-' P
City: _ Miami Shores State: Florida Zip: ast
I hereby cei -tity that I Understand that file zoning foi- this property is for single - family residential use and that it is
irirlawful 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 tieing 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 Maine: (' "'
M
Signature:
The rnrewiing instrument was acknowledged before me this
day or 20)a. by _jj� f
who is p'.. IV-515, to me or who } 5 pmducrd
As identir act who did •ai ath
NOTARY PUB 1C: _' �' °a��h 2p t•
Sign:
Print:
My Commission Expires:
lfdi6tttit
Building Officials Approval:
REV 4 -10
Re -Occ $60.00
Notary $5.00
Total $
QR� MIAMI SHORES VILLAGE
Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
�"res sK s
Tel: 305 - 795 -2204 Fax: 305 - 756 -8972
Permit No. REOCC -05 -19 -1241
Certificate of Re- Occupancy
Address: 9701 NE 4TH AVE
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:
A -Le