REOCC-02-24-410 1043 NE 98 StMiami Shores Village
RE -OCCUPANCY
APPLICATION
Contact Name
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
.27
Permit No. Ebx_' bo—i 410
Phone#:
Buyer: G✓1 Seller: IZv+i%; (,U4a e,e,44er, , LcJ; (I Q','.
Realtor:'; c'LAcr 2:,tX'_U_ Q_C Company Name: 6�fc.. 6Qr V, c,.li {-L Cow, p
Property Address: 1043 IJ E Te g
City: Miami Shores State: Florida Zip: 33
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 foregoin instru edged before me this o�
day of —�", 20� by ��__11, �,���f'��
who is personally known to me or wh qas prod ced-1'-L
L( c— As identification and who did take an oath
NOTARY, PJJBLIC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
KRISTINE KEPPLE YAO
a Notary Public • State of Florida
Commission # HH 452227
y Comm. Expires Oct 8, 2027
Bonded through National Notary Assn.
Re-Occ $60.00
Notary $Z AB —
Total $ (p0_9-0
REV 4-10