REOCC-10-23-2426 1240 NE 97 StMiami Shores Village
RED' EIVEL
RE -OCCUPANCY
APPLICATION
Contact amei
Buyer: 48 � �l Gl
Realtor:
Property Add
Building Department OCT 0 2 2023BY.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.&0E,06C " �D' Z3-2g7,Z ,
clb€� V1� Seller:
City: Miami Shores State
Company Name:
5-a-
Florida
J��rvl v4A_
" I R62 i �,
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.
APPLICANT'S AFFIDAVIT: Ice ifythat all the foregoing information is accurate.
Applicant Name:
Signature:
The foregoing instrument was acknowledged before me this 7--
dayof0 0_1 20?3 by AEE41-
who is person al€ kn to me or who has produced
As identification and who did take an oath
NOTAIIRY PUBLIC: l ,
Sign: 1 )�.. � `-` \C?`
Print: V I J I f-►^ re-- Na,:)
My Commission Expires: 3 ��
Building Officials Approval: ` Re -Ott $60.00
Notary
Total $ % O - "
REV 4-10