REOC-09-19-2283Miami Shores Village
Building Department SEP 2 s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 /}
Tel: (305) 795.2204 Fax: (305) 756.8972,
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit Nn. eoc__
APPLICATION
7,(-6 -557
Contact Name:
Buyer: Seller:
Realtor: il, e .� � ! Company Name: �r� j7 ,
Property Address: &. , 4 -ul z�-
City: Miami Shares State: /� 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
Signature:
The Forego'
day of .20 49, by
who is personally known to me or who has produced (�
As identification and who did akc`sltla i
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tilt
NOTARY PUBLIC: r
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Sign:
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Print:
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My Commission Expires:
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Building Officials Approval:
Re -Occ $60.00
Notary $5.00
Total $ (0 S - a/c,
REV 4 -10
°RCS MIAMI SHORES VILLAGE
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Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
f�astiu� Tel: 305 - 795 -2204 Fax: 305 - 756 -8972
Permit No. REOCC -09 -19 -2283
Certificate of Re- Occupancy
Address: 102 NW 109TH ST
City: Miami Shores
State: FL
Zip: 33168
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;
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