REOCC-01-24-82 1300 NE 102 StY�=C�IVZD
M.
JAN 1 6 2024
RE -OCCUPANCY
APPLICATION
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
PermitNo.
Contact Name: �l G-Ct {'C'(�} C` ( �lI- _Phone#: lw&
/� 2
Buyer: i IM FYI & /'LYnj^ Seller: 9a t42 l
e� C - P4_41 11-0
Realtor: O M i /?4E Z Company Name: g eOLCA ron_� 2'Pa-` �5l
Property Address: l3D0 M57 /04- FL 33138
33/3g
City: Miami Shores State: Florida Zip:
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
Signature:
The foregoing instr "ent
�,ersona
was acknowledgedbefor a /efthis
day,,20�by /
wh P_ C7o,
known to me or who has produced
As identification and who did take an oath
TARY PUBLIC,
Print
*? `, MYCOMMISSIf3Nlltii9061568
Nly Commission Expires. ray; EXPIRES: Septernbtf 19, 2024
Bonded ihru Notary Public Underwriters
Building Officials
REV 4-10
Re-Occ $60.00
Notary -If —ow -
Total
$ il()•G)