REOCC-12-23-3036 913 NE 98 StMiami Shores Village
K
RE -OCCUPANCY
APPLICATION
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30S) 762.4949
ff�� 06 2023
iCry_-
Permit No. 9,5&6 -1 -a3 "9c; 3
Contact Name:
IM o, l ke v
Da Age,
Phone#:
Ruver. J OLSvl^
Sannef 5
Seller: Maas )ie"" Dod,ci
51�- � D, _ 0t61
N
Realtor: H Ck 1 t V Dc)(X Q- Company Name: Co ass — Pc, )e• Dod e C"rou P
Prooertv Address: ` NI E �� 5 )
City: Miami Shores State: Florida Zip:
3313Y
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:,
Signature:
The foregoing instrument was acknowledged before me this
day of bt(e mhe r, 20 a3 , by
who is personally known to me or wh as roduc d
C As identification and who did take an oath
NOTARY PUBLIC:
Sign: _!� -ff,,
Print: �i �� f, . `fft-'--->
My Commission Expires: f oh
Building Officials Approva::S;
V
KRISTINE KEPPLE YAO
Notary Public - State of Florida
Commission H HH 452227
My Comm. Expires Oct 8, 2027
Banded through National Notary Assn.
N
Re-Occ $60.00
Notary
Total $ fn L - 00
REV 4-10