REOCC-07-23-1833 108 NW 111 STMiami Shores Village
RECEIVED
RE -OCCUPANCY
APPLICATION
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
JUL 2 6 2023
BY: 1,b
Permit No. lr,- ol_ ?3 - I b
Contact Name: ;� - � US c Phone#:: � 6 =Z6� -2%l
Buyer: Ale ei/vtr_/iD teem Ojco_r ��c�Seller: Al
Realtor: s i s _ Company Name: �� �r (�,�, �jr'�, 1�c<e
Property Address: o 1 uJ i i) S
City: Miami Sho
State: Florida Zip: 3-7 / G Y
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: ' 1 e Sus S O
Signature:
The foregoing Wstrument was acknowledged before me this _
day of V�-- 2023 by ��SuS ��''t�
who is personally known to me or who has produced
4._1 VIL As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials
4ly C0MMjSs10, k # GG 950477
EXPIRES: March 6, 2024
Bonded Th{u HOLI.ry Public, Underwriters
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10