REOCC-06-20-1144ORE MIAMI SHORES VILLAGE
Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
'ioivA
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-06-20-1144
Certificate of Re -Occupancy
Address 9701 NE 5TH AVENUE RD
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
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Nami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMSER: (305) 762.4949
RE -OCCUPANCY
APPLICATI+E)N
Contact N 1 ej:,, , a row
Buyer; V t i U" }�
Realtor: '1 e o
Property Address: 'I I
VI
Permit No.
Seller: ���G� �`�i _1AU, &50'M , Inc —
Company Name:) 1�e 1Lw yy'l1j r j � [�
City: Miami Shores _ State: Florida Zip: 7
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 Miauni 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 Name�L�"`�
Signature:
The foregoing instrument was acknowledged before me this
day of . 20 ___.., by
who is personall
y }mown to me or who has produccxi_! �_ •_ �`
As identification and who did take an oath
NOTARY P IC:
Sign:
Print:_^ff1 ii" iIL cl�
My Commission Expires:
Building Officials Approval:
REV 4-10
?�•► .`c » Nora1y public • st'l
`
Commission # GG ow"46r
=��F,
�' My Comm. Expires Oct 31, 2i;2G
' �++�+�"' Bonded Ihrouph National NolaryAssn
Re-Occ $60.00
Notary $5.90
Total $