REOCC-23-1432Shores Villa e
Miami Shor g
Building Department
artment
10050 N.13.2nd Avenue, Miami Shores, Plorida 33138
Tel: (305) 795.2204 Fax: (305) 756.9972
INSPECTION'S PHONE NUMBER: (305) 762.4949 r
RE -OCCUPANCY Permit No.
APPLICATION
Contact Name: Irn e S Ll l n+Q'r 1�(7 f r T
Bu_w -iI ,Ji4 & Seller:
Realtor: N a N Br 13 ; v-' Company Name:
Property Address: (o Z ST
City: Miami Shores State: Florida Zip: I
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
Signature:
The foregoing instrument was acknowledged before me this
day of , 202 , by —rq
who is personally known to me or who has produced_4L—=`
As identificad n and who did take an oath
NOTA P IC:
Sign:
Print: MY COMMISSION # GG 950477
l{P{RES: Mar: h 6, 2024
!,' ' Bonded Thru Nota Public Underwriters
My Commission Expires; � a
Building Ofiiclals Approval:_ _ _ � ,CJC��L3
Re-Occ 60.D )
Notary $5.00
Total
REV 4-10