REOCC-10-23-2427 9305 NE 9 AveMiami Shores Village
RECEIVED
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
C C T 0 2 2023
I3Y:
RE -OCCUPANCY Permit No. ft oC'-jC)-23 --2_q2_*
APPLICATION
Contact Name: J� � C Phone#:
Buyer:\ 1��t Seller: �e_n
Realtor: Company Name:__T� Nc_ L_j
Property Address:
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,,hat all the foregoing information is accurate.
Applicant Name:
Signature:
The foregoing instrument was acknowledged before me this Z-
day of OC-4 , 20 Z3 , by V0_V1 e 55«
who is personally known to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: &_ . _
Print: V ( ✓ I -C )1Y-L' y OL�;'
My Commission Expires: I / 3 , /
Building Officials Approval:
Re-Occ $60.00
Notary 0
Total $ Cb 0. 5cp
REV 4-10