RE-OCC-06-20-1255° MIAMI SHORES VILLAGE
Building Department
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`��res°LE 10050 N.E. 2nd Ave, Miami Shores, Florida 33138
to Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-06-20-1255
Certificate of Re -Occupancy
Address- 141 NE 109TH ST
City: Miami Shores
State: FL
Zip: 33161
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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RE -OCCUPANCY
APPLICATION
Contact Name: _
Buyer:
Realtor:
Property Address:+—
City: Miami Shores
Miami Shores Village
-Bu'lding Department
10050 N,E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795,2204 Tax, (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762A949
Permit No.
06/16/2020
REOCC-06-20-1255
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I hereby certify that l 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 AFFWAVIT.- 1 certify that all the foregoing luformation is accurate.
Applicant
Signature:
The Coa o
flay o
%aho who has produced
As idcniffi *' ' and whn Jid take an oath
NOTAR P IBLJC
Sign:
Print: < c N I
Ivly Cc
Building Officials Approval,
REV 4-10
SnK;' KERRY DIAZ
MY COMMISSION # GG 111255
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r EXPIRES: June 17, 2021
cBonded Thru Notary Public Underwriters
Re-Oce $60.00
Notary $5.00
Total $