REOCC-01-20-159Miami Shores Village
Building Department
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
APPLICATION
J
Contact Name: `� C� �j". �'.2
Buyer: Seller:
iEN'TEnED
JAN 2 J 2020
BY: C<!�)
Permit NO.4?eOC C. - D 1 _?_0 ' V5:F4
s�
Realtor: Company Name: I N 1 �l l Qv✓t^ S �'�
Property Address:__ 1 ay a. KC1' 1 bq TT_.
City: Miami Shores State: Florida Zip: 3 3 9
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 fore ingi s - iment was acknowledged before me this _3
days f '.6, 20 ,�22, by
who is rsonall own to me or who has produced
As identification and who did take an oath
NOTARY P C:
Sign:
Print: 14.4
My Commission Expires:
Building Officials Approval: _
REV 4-10
cHARLES M.KLUCK
Notary Public - State of Florida
Commission # GG 009467
My Comm. Expires Oct 31. 2020
Bonded throughNahnnai'
a
Re-Occ $60.00
Notary $5.00
Total $
MIAMI SHORES VILLAGE
Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
R11D
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-01-20-159
Certificate of Re -Occupancy
Address: 1242 NE 104TH 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