REOCC-10-23-2504 334 NE 102 St1RV -ME., 40 C EIV EI)
OCT 11 2023
BY:
RE -OCCUPANCY
APPLICATION
Miami Shares 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
Contact Name: V� n e e h t� b U r� ; a
Buyer: E�ir6 l�$ /�a S2 //O
Seller: 3 3 q
Realtor: V/h C e n f 1"& rq ja Company Name:
Property Address
33y /42-"d St.
City: Miami Shores
Permit No. CC Io-23 —2S;_04
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Cor7p A S s- F'lor la'a L4 C
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 i a)cl M�l91 lll� but It C
Signature: lJl1�l?�R J 1�Jt It 1 U FIV
The foregoing instrument was acknowledged
before me tht's
day af,20�,by who is personals+y known to me or wha has dd
As identification and who did take an oath
NOTARY
Sian:
Prin(; V) orr-; Lo v im m
My Commission Expires: I / aS
Building Officials
REV 4-10
(0) q Z--�
MARCI LOWMAN
Commission # HH 143226
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Expires July 9, 2025
10F: f.
Bonded Thru Budget Notary Services
Re-Occ $60.00
Notary $*.:QP
Total $