REOCC-07-23-1783 33 NE 93 STMiami Shores Village
Building Department noa 61 inr
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 C13AMDax
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit NXE66L - 0 7- 03
APPLICATION
Contact Name: L' l P S l- Y I` ea r C e Phone#: 3 c) S - �q 0- 533 `
Buyer:
Realtor:
Seller: john Zel I n a
S l e c) r c, Company Name: ea I
G2-0 -ci-
Property Address: 3 - 1N
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 Nam
Signature:
on(e- Io Scgy-e n'
The foregoing instrument was acknowledged before me this I
day of 20Z3 by4 C&nt-e�
who is personally known tome or who has produced
,{ �",-3 %�-c. As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print- V % V I e—n""—
My Commission Expires:
Building Officials Ap
Vivienne Yao
C6mm.:HH 222410
r��a•,n°
Expires: San. 31, 2026
�«�`�
Notary Public • State of Florida
t 3
ej
Re-Occ $60.00
Notary
Total
REV 4-10