REOC-10-19-2398RE -OCCUPANCY
APPLICATION
Miami Shores Village RAC cE t v, Era
Building Department
10050 N,E.2nd Avenue, Miami Shores, Florida 33138j
Tel, (305) 795.2204 Fax: (305) 756.8972
X1
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No, -p (ACC e 10 rIq- c,9_3q6
Contact Name: v(L 5 Phond:190 2 Sle 13 Z-1-
13uyer; 1<<-k'" �i��.c ., `�1s7C�s� Seller:
Realtor: l - -- __Company Name: 2-
Property Atldress:1 M\Pj 1
City; Miami Shores State: Florida
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 he issued by Miami Shores Village certifies only that the referenced properly is being used for single family
purposes and that such certificate does not constitute any representation, warranty or cerlification as to the
condition of (lie dwelling or other structures on the property.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
�1pl�licant Naunr: .� i _17
_
111c: for% oin ins runlent was acktunvkvt , rc me this 10
clay of 20 Et, by a?f -
!►llllilt1111!!
who is ip�ersorially known to nic or who has produced�� ������� ODY PR.
't 1Q r�tC] ]a; ieirntiiication cull who slid lake an oath ��: GgM�S�eN 0'�
La [�Y
AR
Print: � vr4AcT,-
My Cn1111111ssio xpires:
Building Officials Approval:
D a AUG 28720
4111100MION
Re-Occ $60.00
Notary J%i.00 _
Total $ 65 a)
REV 4-10
°"E MIAMI SHORES VILLAGE
UN T Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-10-19-2398
Certificate of Re -Occupancy
Address: 10 NW 100TH ST
City: Miami Shores
State: FL
Zip: 33150
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
r