REOCC-10-20-2254Nnf_+s2'°s MIAMI SHORES VILLAGE
Building Department
��vRiv 10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-10-20-2254
Certificate of Re -Occupancy
Address: 41 NW 109TH 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
Building Department
i 050 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
Contact Name; ��ar� �� �
Buyer: LE
Realtor:
Property Address: -4' i
P,_E,CEIVEID
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BY:
Permit No.20CCC-U-20— )2�'e\-
Phone#: l�o3 l 3 D ?)
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.Company Name:
City: Tv iami Shores State: Florida Zip: �
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 Name, ka
Signature:
fTheo oing st was actinowiedged before ale this 0
dayofr4r0� by�
who
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is personally known to ine or who has produced 0-4dR
�r'�f' � �s t• s identification and who did take an oath
NOTAR
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Building C)CPicials Approval:
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Re-Occ $60.00
Nolary S5.00
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