REOCC-10-20-2352MIAMI SHORES VILLAGE
Mill' 11 Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
�10RION Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-10-20-2352
Certificate of Re -Occupancy
Address: 131 NW 110TH 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
rt--y •-� EIVED
RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. 1, e6C•C' i o - 70 - 2352
GL� 14M F717AMv Phone#: %9 G 9h 8 (0 Z Lf%
Seller: j6-M4A Altl&A±wo)
Realtor: /[I GG .1 D� Company Name:
Property Address: 3 AO J TWT-% 11111a,S ref 331l �
City: Miami Shores State: Florida Zip: 3��6
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 thekein. 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:
Signature: - The foregoing instrument was ac 'wledged before me this LP
day of QQ+01oef, 20V , by l0 M 16--1*6 �
who is personally known to me or who has produced-
-Or \\J?-V `S UC•t'h'S_As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print: --,e«na f't�v�,� `
My Commission Expires: M arC l_, 1-21 'Z02�
Building Officials Approval:
SELENDIJd
MY COMMISS
EXPIRES.
o= M
Wnd9d ih ,Nota
Re-Occ $60.00
Notary $5.00
Total $ (0 S . 0 0
REV 4-10