REOCC-05-23-1237Miami Shores Village I Building De �--
a rtment
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795,2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 76L4949
RE -OCCUPANCY Permit No
APPLICATION CaL( 1�n'147 76)16 3 ^ ) S j j
Contact Name:
(-+5r 6r0 { 4+ 4
_ __Phone#: fta- 4-114 1b
Buyer: „ 50PL.4 j!di
0 -1 ;&►s . LA, L. -
- Seller: A ((I,%
A'%A (% Sa & o►Id +%4A - --
Realtor: 4
Sq4 ` f5
Company Name:
_ 4 w!y es Co .
_
Property Address:
56 N c 12_T xy
S�, AA �`g,j;
i
5k.o res � --
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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 Name:,_ S
The foregoing instrument was acknowledged before me this
day of.(kA 2025by ��
who is personally known to me or who has produced
As identification and who did take an oath
NOT Y f YBLIC:
Sign.'
'V �
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Print: em I1/1 Gl N I L 0 l ii iiL
My Commission Expires: 0i Z LP la
Building officials Approval:
..YA.rr EMMA NICOLE NEWITT
�? Notar¢ Public, State of Texas
Comm. Expires 01-26-2026
Notary ID 133552948
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Re-Occ $60.00
Notary L5.00
REV 4-10
Total