REOCC-06-23-1555 10642 NE 11 CTRE -OCCUPANCY
APPLICATION
Contact Name: — a
Buyer, ,r%'\ 1v o 1
Realtor.`�5r;` tU
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PRUNE NUMBER: (305) 762,4949
V $ C.
C. Seller: A\cv,(
Company Name:
Permit No. f 6oee 06 23 (55 S
a --ems 901
C 0\ w 1
Property Address:
City: _ Miami Shores State: _ Florida Zip:
1 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.
APPLICANTIS AFFIDAVIT: I certify
Applicant'
the foregoing information is accurate.
Signature: T_
The foregoing insnu ent was acl.nd wledged before me this
day of -_.e, 20 1:-3, by —Y-�D n yncAv%, :e_
who is perSR1nown to me or who has produced
rAs identification and who did tape an oath
NOTAR
sign:MAU— - --
Print: nEFEN
My Cammission Expi My COMMISSION # HH 33006
"°`.' IeXPIRfeS: November 26, 2026
Building 0111clals Ap T
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10