REOCC-10-23-2576 10001 NE 1 AveMiami Shores Village
Building -Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tr1- (305) 795,2204 Fax: (305) 758.8972
INSPECTION'S PHONE NUNMER: (305) 762.4949
RE -OCC
UPANCY Permit No. CC- — f O -Z3- '2�O
APPLICATION
Contact Name:20�2—c—� �J L� V! Phone#.. 7
Buyer: � �- � ��
Seller., V a
Realtor: 0o3 any Name:
L
Property Address:
City: Miami Shores State: Florida :alp:
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 AFMAVIT: I certify that tall the foregoing info�-=tion is accurate.
:A'pplicant
Signatures
The far Ding in meat was a wledged bafore this �.
day ofabV
who is P wirre who has produced
As idenUcation and who did take an oath
Sign:
Print:
My Commission Expires:
Building 0Mdals Approval, --
REV 4.10
MY COMMISSION # HH 109171
EXPIRES: June 17, 2026
Bonded Thru Notary Publie U�+r
Re-Occ ,$60,0 )
Notary 15.00
Total $