REOCC-04-23-956RE -OCCUPANCY
APPLICATION
Contact Name: V_'Ic
Buyer:
Realtor: i
Property Address:
Miami 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
IIAS
Permit No. �`Cl)A?):NQ
Phone#:?"o5,-Ag(5 ' Ooll
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
The foregoing instrument was a owledged before me thi
day of WU . 20� by �.� ��� .
who is personally known to me or who has produced
d71� • As idf ntif-cation and who did take an oath
NOTARY PUBLIC:
Sign
Print:
HEMT MWINEZ
My Comm' siion Expires:; •' My
COMMISSION 8HH323278
EXPIRES: October 18, 2026
Oi f1 .
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total $ 40,00
REV 4-10