REOCC-23-1316Miami Shores Village rr
Building Department
artment
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 Permit No. �Z 3 3 �P
APPLICATION 6DwA-aD Woos C 3os� �3s
Contact Name: _A% �*C'� Phone#:
Buyer: M S L L� Seller: 1/ Pri1-r7 Ll�
Realtor: Company Name:
Property Address: /J�
City:
Miami Shores
R2 ST-
State: Florida Zip:, 3 3 1 5'9 .
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
�ktr� v✓'�h'C,H _
r
The foregoing ins ument was acknowledged before me this
day of 20 Z by
who is person lly known to me or who has produced
As identification and who did take an oath
Sign:
MyCommissnExpires: 31 . 202b .
Building Officials Approval:
REV 4-10
aU4//
Daniela Cohen
=�4rpY 4
�_•: :1�
Comm.:HH248091
March 31, 2026
•
Expires:
\�`
/••�u,,,�t,�••\ Notary Public - State of Florida
Re-Occ $60.00
Notary 5.00
Total $