REOCC-08-23-2137 163 NW 102 StreetRE -OCCUPANCY
APPLICATION
Contact Name: 1e nn
Buyer: t`
Realtor: =ffin ` �fv,
Property Address: Il O
City:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (2305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. Rom " Ub - )3 - ,-9 13 -7
GIAD
Miami Shores State: Florida Zip: 33 � SJ -
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: Y r
Signature: q
The forego" g instru en( was • kno ledged before me this 2 1
day of U 07a, by N So- 1)<-Cell
who is personal nown to me or who has produced
As idea ' ca n and who did take an oath
NOTARY PUBLIC: [ L
Sign:
Print: S i1
My Commission Expires:
WBuil°`•' HEBERTMARTINEZ
'•' MY COMMISSION k HH 323276
ding Officials Approval: :Po�:��*''
` EXPIRES: October 18, 2026
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10