REOCC-06-23-1627 487 NE 100 ST-bk-3 ,.-I I i'9 Q
Miami Shores Village
Building Department
10050 N_E.2►ad Avenue, Miami Shores, Morida 33138
Tel: (305) 795.2204 F91: (305) 756.8972
INSPECTION'S PHONE WADER'- (305) 762,4949
RE -OCCUPANCY
APPLICATION
Contact Name.
Buyer: Seller.:
permit No. jj Cad 6 - 06 - 23- l6 z 7
837b
Property Address:
City: Miami, 5hzes State:
I hereby certify
that I understand that the zoning for this property is for single-family residential use and that it is
unlawful fox more than one family to reside therein. I also understand that any Certificate of Ra-Occupancy that
may be issued by Miami Shores V MW c0W ies only that the referenced property is being used for single family
Purposes and that such certificate not constitute any representation, warranty or certification as to the
condition of the dwelling or other structures on the property.
APPLICANT'S AFI+'IDAVIT: I certify that all the foregoing 10formation<1s accurate.
Signature:
The foregoing instrument was acimowledged before me this
who is y wnr who hasproduced
As identification and who did take an oath
PUBLIC:
Print: —
My Commission gxpires:
Building Of lcclale
REV 4-10
myrommisgio d # Vi 109171
EXPIRES:Ju 2025
Bonded Thru Notary P rfg4e
Re-occ $da.aa
NoUWYINT
Total