REOCC-10-23-2476 300 NE 103 StRE -OCCUPANCY
APPLICATION
Contac
Buyer:
Realtor
Properi
Miami Shores village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RECEIVE�L.
OCT 0 6 2M
BY: ti
Permit No. RCOCL — 66 —Z-3 - 24 7fv
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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name: �"
rr —,4
Signature: - I
The foreg — men( was a no d before me this
dayofJ(-hbe,1.203�X by t 1 tl 42 n Ie_ C J,�R
who i ersonally know me or who has produced
id enIificat ' and who did take an oath
NOTARZP C:
Sign:
My Commission Expires:
Building Officials Approva
y ERICA J. JUNCA
t Notary Public
a State of Florida
Comm# HH238842
91 . Expires 3/20/2026
Re-Occ $60.00
Notary -
Total $ 6 6. CO
REV 4-10