REOCC-05-23-1251Miami Shores Village
RE -OCCUPANCY
APPLICATION
Contact Name: V v e S
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. S-2-a'- f2s(
Phone#: 3O-1S -79 O. 3323 l
Buyer: t" � �• tact.-. , S+� ��ie � co"Seller: �, o �' �,r-e,.,.� -e
Realtor: W 0- S Company Name: n -k�-� t yc-
Property Address: SS
City:
Miami Shores
State: Florida Zip:
33i�8
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 acknowie ged before a this
day of� 202 by -��� -
who is personaw known to me or who has p oduced
QL ' As ia�entification and who did take an oath
A.
NOTARY PUBLIC:
Sign: Y
Print:
My Commission Expires:
Building Officials Approval:
HEBERT MARTINEZ
'•: MY COMMISSION * HH 323276
EXPIRES: October 16, 2026
Re-Occ $60.00
Notary $5.00
Totals CPE-°�)
REV 4-10