REOCC-10-20-2255JID�)')
MIAMI SHORES VILLAGE
lit, Building Department
10050 N.E. 2ndAve, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-10-20-2255
Certificate of Re -Occupancy
Address: 1201 NE 101ST ST
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
RE -OCCUPANCY
APPLICATION
i
Contact Name: -L 0�
Building Department il'r 0 5 ?020
10050 N.E.2nd Avenue. Miami Shores. Florida 33138
Tel: (305) 795 2204 Fax: (305) 756.8972 +13Y.
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INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.Qec=- C(Y 2-0- 2?-SS
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Buyer: ircty 5 l Seller: ��C&M N)���tu writ 1 �kj (t _ Poole
-
Buyer: '�IaMcW��I%� �^ Company Name: _�►� s �n i Cd�1Go�r.��
Property Address: 1,2 G
City: Miami Shores
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�.,. SL
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 Now:
Signature:
The foregoing instrument was acknowledged hefore me this
day ol'QC_±0N0ejL_ .2020.hy—�--ralvtg F.740tN Cr0VW'+0t1 C-Itbb
who is personally known to me or who has produced,��T
�)6Je'r�S UCEt1S-e As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print: ae,�kcnci 41� CDdQ
My Commission Expires: r-4amVi 22 �92
Building Officials Approval:
REV 4-10
SELENA ARANDA
MY COMMISSION # GG 971705
EXPIRES: March 22, 2024
nor fi4. bonded Thru N ot9fy PublIc Underwrllers
Re-Occ $60.00
Notary $5.00
Total S • C�O