REOCC-06-23-1550 309 NE 99 STMiami Shores Village,�EIvED
RE -OCCUPANCY
APPLICATION
Contact Name:
Building Department JUN 10 2O23
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 $Y:
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. �? 3 —/ 5s-�D
Phon.#:�-b3 145- 31�2
Buyer: I
' / Seller: 1�0Y ``ILP]
Realtor: "/1N_6� C�
Company Name: 1�C
Property Address:J3L 2 gE 29 - -
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
Signature:
r �
The for-eggoing instrument was acknowledged be ore me this
day of'Jvh 20�-L by
who is personally known to me or who has produced
As ider(tification and who did takOn oath
NOTARY PU LIC:
Sign:
Print: : 4'�Y p`'•
My Commission Expire `:yF
Building Officials Approval:
REV 4-10
ARLENIS S�} G� # 50477
CP ES: Mgrch 6.2114
i hjufvOlery tubiioUnderwrbrs
Re-Occ 960.00
Notary $5.00
Total