REOCC-11-23-2929 117 NE 95 StMiami 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
RE -OCCUPANCY Permit No. e6OLC - 2-3 -2-g09
APPLICATION
Contact Name: NL_Phone#* 186— Z-W —367"_9
Buyer:.._., - 1 � �- -- - Seller: To,w 4. v
Realtor: Company Name: Vm_�'
Property Address:
City: Miami Shores State, Florida
zip: -33 1 -t3
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: % C. lifz'[A
Signature: Ma*WIei. PAja
The foregoing instrument was acknowledged before me this
day of 2021 byl:
who is ers jally-knawn tome or who has produced
As identification and who did take an oath
NOTARY UBLIC:
Sign:
Print.
My Commission Expires: 1.i� p4,��,, p, 2Q7-,6
Building officials Approval:
REV 4-10
MA,My
iSMER ACOSTA
Notary Pobiie-State of Florida
Commission# HH 247096
Commission Expires
',■, � `` March 30, 2026
Re-Occ $60.00
Notary $5,00
Total $ 6 5. 00