REOCC-09-23-2328 30 NE 105 StMiami Shores Village�T`a
Building Department
10050 N.E.2nd Avenue, Miami. Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S FROM MJMMFR: (305) 762A949
RE -OCCUPANCY Permit No.;
APPLICATION
Contact Name: Phoned#: G 376
Buyer: G-0 � � a Seller: C7
Realtor: C �� w- VLF Company Name:
Property Address:
O
City: Miami Shores State: _ Florida Zip:
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.
APPUCANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant'.
Signature:
0
The f g ' g instrumr nt was.
— wiged before me this
20L4-
day,6
jofii--4wharn or who has produced
Sign: 7
Print:
My Commission
Building Officials
REV 4-10
As identifieatinn and who did take an oath
MY CO�A�}155lC{�1 # HH 109171
EXPIRES: June 17, 2025 PP
Barr�ad 7hruHoloryPv6lioUnrlenI41:
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Re-Occ $60.00
Notary $5.00
Total $