REOCC-12-23-3178 685 NE 97 StRE -OCCUPANCY
APPLICATION
Contact Name:
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
U EL 2 2 2023
�i
Permit No. REceC-19-a3-317�
Buyer: C-7--1 J�: Z I j2�& Seller:
Realtor: PA-T. Ric Company Name:
Property Address: 63 5- ^JE a. -I S:
City: Miami Shores _ State: Florida Zip: _33i3e
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. 0-r c�< I-
Signature:
The foregoing instrument was acknowledged befbrd me this
day of , 20A3. by ' i`C1C L
who is personally known to me or o has
IrY produ d
'O& L C_ As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials
REV 4-10
KRISTINE KEPPLE YAO
w.,am puhlic - State of Florida
Commission N HH 452227
My Comm. Expires Oct 8, 2027
d through National Notary Assn.
Re-Occ $60.00
Notary-:
Total $ ��--
66 Qv