REOCC-10-23-2456 10357 NE 6 AveRE -OCCUPANCY
APPLICATION
RECEIVE
Miami Shores Village
Building Department BY.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Icy
Permit No.
Contact Name: E-57 C _4 M &-jkJ _�) ' E-7-t-1 Phone#: L-30'),606 - 06-S
Buyer: C-1 E-012 C-> t f L LL—A Seller: E57EZ A _:,�) ; L-7 y:N
Realtor: 1Z 1 Lt<, NGEL Company Name: 5 U L W-40D l-f4MG7-5 j/VC
Property Address: l 0 E 6-+k A Vt
City: Miami Shores State: Florida Zip: 33.1 3 ??
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 V1H-age 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.
'n vent as ac ov.{cdgFd before thisZD
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who is pVsonally known to me or who as produced
As identi ficatio " di an oath
NOTARY PUBLIC:
Sign:
Print: 'u5
My Commission Expires.
1 y Pai
Building Officials A
REV 4-10
HESERT MARTINEZ
MY COMMISSION # HH 323276
EXPIRES: October 18, 2026
Re-Occ 6 .00
Note .00
Total $ W .00 -