REOCC-08-23-1915 987 NE 96 STRE -OCCUPANCY
APPLICATION
Contact Name:
Buyer:
Realtor:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miam' Shores, Florida 33138
Tel: (305) 795.2204Fax: (305) 756.9972
INSPECTION'S PHONE NUMBER: (305) 762.4949
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Seller:
Comp y Name:
C'T
Permit No. � 06e _09, --Z.3 . ME
Phone#:--Ig(o Z�g 1 '� 7G
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City: Miami Shores State: FloridaP�
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 Villge acertifies only that the referenced property is being used for single family
purposes and that such certificate does not constitute any rep3relerl<tation, warranty or certification as to the
condition of the dwelling or other structures on the prWertY•
APPLICANT'S AFFIDAVIT: i certify that an the fioregoilRa iuforumtion is accurate.
Applicant Name` �-
Sippature: !
The for ing iUSUW ent wastnowledged before me this
day of . 20a by SIN-el
who i pers all Imown to who has produced —
As identification and who did take an oath
Budding Offictab
REV 4-10
t,;a� ?q; •: KERRY DIAZ
N!Y C0MM155t0H # HW 109171 `
E5: Jule 17, 2025
,PAW Bonded ThruNOWYPublic llndenxWQ13
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Re-Oce $60 00
Notary
Total LA�