REOCC-04-23-1033t1�r Miami Shores Village
Building Department
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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) 762.4949
RE -OCCUPANCY Permit NX. �� -72)- R3
APPLICATION
Contact Name: dt"n lily TyibKyhn Phone#41?,,�U-1 F5
Buyer: 0MV An-hQua, Seller:O r--Moyntm Jr.
Realtor:-4 tDyLinrrl Company Name: D�fYI DQ 5S
Property Address:
City:
Miami Shores
State: Florida Zip: 33150
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 Na
Signature:
Y Vl� 0
The foregcQ instrument was acknowledged before me thi
day o�, 20 S by 011
who is personally known to me or who has producer!
Pq -L+ • j is identificatiin and who did take an oath
NOTARY PUBLIC:
Sign: =��': HEBERTMARTINEZ
•" MY COMMISSION ak HH 323276
Print: `'%r' EXPIRES
,,,oP#Yo,.• . October 18, 202B
My Commission Expires:
Building Officials Approval:
Re-Occ $60.00
Notary�
Total $ W.00
REV 4-10