REOCC-08-20-1927° £S MIAMI SHORES VILLAGE
Building Department
�tirsL� 10050 N.E. 2nd Ave, Miami Shores, Florida 33138
tv�tiv� Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-08-20-1927
Certificate of Re -Occupancy
Address: 5 NW 107TH 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
Miami Shores Village
RE -OCCUPANCY
APPLICATION
Contact Name:
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30S) 762.4949
Permit No.
7!b--Z-3c?-Q390
Buyer: _f. t V) V'l M Oy�]
i-Seller: 0Ue [ .G d
Realtor: N' Cornpany Name:, tjI A
Property Address: �v i� i►lj -7 TO
City: Miami Shores State: Florida Zip: 3 3 I 1r" g
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 certifythat all the foregoing information is accurate.
Applicant Name: a p''pq `�
Signature: ! v " I L/ '
The foreg _ g ins t was acknowledged before me this
day of PY,C t 20 2�j by _fOy,C�2 //V
who is personally known to me or who has produced Fj_
i4D L�-�g5:5-3476
As identification and who did take an oath
NOTARY PUB_ C:
Sign:
Print`
My Commission Expires:��''
Building Officials Approval:
,REV 4-10
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Re-Occ 8 50.00
Notary $5.00
Total