REOCC-23-1165Miami Shores Village REcEIvmT
Building Department MAr 1 0
10050 N.B.2nd Avenue, MiaTW Shores, Florida 33138
Tel: (305) 795.2204 Fox: (305) 756.9972
INSPECTION'S PHONE NUMBM- (305) 762.4949
RE -OCCUPANCY Permit No.
APPLICATION
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Contact Name: ' " c i �l -� P 012 :
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Brayer: � � Seller: 0
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k8ealtor. ;'� Cpompany Name: '
Property Address- V3
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 cerft that all the foregoing information Is accurate.
�Appllea�t'
Slgnabmre:
The foregoing instrument was a I —11ged bdore me this
day of by...
who _ ers to r who has produced
As iderdii7cafm and who did take an oath
Sign:
Print.
y L— _ MY C'�]AkM15510 HH 109171
M Commission Tres: =� = �T}
`1• ` �•° EXPIRES: June17.2025
y•.n a. Bonded Thru Notary4blic Unde tors
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Building Offidals Approval: 77,
Re-Occ $60.00
Notary $5.00
TOW $
REV 4-10