REOCC-07-23-1659 544 NE 106 STRE -OCCUPANCY
APPLICATION
Contact Name:
Miami Shores Village
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
ct< /_ "T-)-SJ
Permit No. aRa - 01-23 _ 1 la�q
Phone#..3 D-2-17c) 4 -Lo yo'3
Buyer: ZU t--u A- - Seller:y-f (C*A-yL- I~- (--IE71 C_',�-tAj t C-Li C*M S
Realtor: A =r-t c 6C IZ:)�' Company Name:
Property Address: &/ E 10 G S:% _
City:
Miami Shores
State: Florida Zip: i c
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: ' c t< I- - -D- s �-
Signature:
The fore ng instrument was ac owledged before e
day oM � , 20 �2) by L•
who is personail known to me or who has produced
� As identi xcati i d w tl o did take an oath
NOTARY PUBLIC:
Sign:
Print: n�
My Commission Expires: , 1
Building Officials
iAl*,.%p HEBERT MARTINEZ
_■: MY COMMISSION # HH 323276
EXPIRES: October 18, 2026
Re-Occ $60.00
Notary $5.00
Total $ 6 cc'�
REV 4-10