REOCC-09-20-2143MIAMI SHORES VILLAGE
Xiii�.: ii Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Rio Rips'
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-09-20-2143
Certificate of Re -Occupancy
Address: 122 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.
Miami Shores Village RECEIVED
Building Department SFP 2 2 2020
10050 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 PermitNo:i,Coj�= Cpj'20-2)`-3
APPLICATION
Contact Name: apillPhone#: 305 ' � 14 - 2-1 low
Buyer: 30 LI le �-OL?SCn� Seller:
Realtor: �AlW ppyosprd Company Name:
Property Address: 2.-. !• W It D-l"
City: Miami Shores State: Florida
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 Nall.1 ' �—
Signature:
The foregoing instrumen�was knowledged be �reme this I
day of 20.2 ,by hJgAl iC7P AJQ LW -,
who QEonally known to me r who has produced
As identification and who did take an oath
NOTARY PUB C:
Sign;
Print: L- roci fA 6esl 610,
My Commission Expires: J0n1€ I Ci, 0-0124
Building Officials
REV 4-10
1:><Y ■.a LUZ CECILIA GRAMEGNA
• art Notary Public • State of Florida
Commission. A HH 010297
a� rti My Comm. Expires Jun 14, 2024
Bonded through National Notary Assn.
Re-Occ $60.00
Notary $5.00
Total