REOCC-02-24-326Miami Shores Village P.P11CFIVEID
3 2U24 1
FEB
Building Department B 1
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No.GQCC -02 - 2_4 - -:�)Z_Cp
APPLICATION
Contact Name: SN(� cwya- Phone# (36) 3
Buyer:��' �C\��(i��." IiUhi` Seller:
Realtor: S t abCt( Company Name:
Property Address: 16 W I (� �ItYU+
City: Miami Shores State: Florida Zip: 331 V e
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:
6)wis r--
The foregoing instrument was Wacknowledged beforeme
this
day of bNA 20� by I � L���Vf�7� v� 1 ✓.
�.._
IF
who me or who has produced
As identification and who did take an oath
NOTAR `I —
Sign: i (�
Print:
My Commission Expires: 'I V.
SGOMMISS�O•••
NUMBER Z
Building Officials Approval: = ZHH 1990o3
XPIRES
�'�.• NoV.15,2025 :•o�=-
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',,',�b�� • Staffs°.�``.
lilt
REV 4-10
Re-Occ $60.00
Nota ryj5m8-
Total $ (6 6) ; 00