REOCC-23-1278Miami Shores Village �RT��T�
Building Department MAY 1 2023
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
By
INSPECTION'S PHONE NUMBER: (305) 762.4949
W
RE -OCCUPANCY Permit No.
APPLICATION
Contact Name:
C�ir°i.��`✓1'�`�H Phone#
Buyer: CYif24k a A)ume Z '• K%Av► '?!'Ye!�J�Yg° a Ier: a(�l�+� .;�✓ia
Realtor: %Z-c400 d Uv14ay Company Name: 11(1aK; kA1,cjrr;Y0'-1 oa
Property Address: / Mi- %OZ ,.1 S
City: Miami 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
Signature:
u
The foregoing instrument was acknowledged before me this.
day of % % 20 23.1 by
who is personally known tome or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign
Print:
My Commission Expires:
Building Officials Approval:
ARLENIS SILVERA
+ U+JM�-MISSION # GG 950477
Exi'IRES: MaMh 6, 2024
So+tided Thru Notary public Underwriters
Re-Occ $60.00
Notary $5.00
Total
REV 4-10