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REOCC-05-23-1144Miami Shores Village 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 RE -OCCUPANCY Permit No.-dt!iff-05 "23 - /1qq APPLICATION Contact Name: LU C44 V- D' 6M ` a4to Phone#: iS 6 2qH _ ,9 3 9-9 Buyer: aQc.L(10'r qc' 1 f+uQs Seller: U lGy'Le,Io C5 to �.'.s G. [� �• e n n� u � r Realtor: �_uC_:c.n' C rYmi_11, 9,a Company Name: Property Address: 1.1 75 fUW q .� H6w 6 �qr City: Miami Shares State: Florida Zip: 3 3 1 512 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: n_c.. �►rV11 b.(4 vet Signature: The foregoing instrument was acknowledged before me this � day of�2023 byCa,,kz-. Qj�►r�� who is personally known to me or who has produced T_'Y ✓ L_� L. As identification and who did take an oath NOTARY PUBLIC: Sin \ / .•`�`�rpY "�e''�. Print: 11� V'L-e_v%r\..0_ 'I OLr, x •. .,r,�n� My Commission Expires: 3 ` I ZDZG �'' niir+'�"• Building Officials Approval: atz' Vivienne Yao Comm.:}iH22200 Expires: Jan. 31, 2026 Notary Public . State of Florida Re-Occ 560.00 Notary $5.00 Total $ REV 4-10