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REOCC-7-23-1682 1160 NE 91 TerrMiami Shores Village Building Department 10050 WE 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 RE -OCCUPANCY Permit No. P \ COZ— APPLICATION ,� Contact Name: 2A-*v Zola_-" Phon #f Z3 703`2s-03 Buyer: a4a/ W4 Seller: cr,� Realtor: Company Name:_ Property Address:ll© &6 33 / 3� 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 instrument was -7a ge before me_this 7%` day off 20 24by "� r who is personally known to me or who has produced___ t«f� f+f , .D7,4tit'/1�1 a� 0 0 As identification and who did take an oath �����IAN y NOTARY PUBIL Sign: Print: - _ ✓i My Commission Expires - Building t �� •��2r% Officials Approval: REV 4-10 O i G�MM�Ssi�'%.� i� G k407, y�•.� ' - FS •� Q i� (j ` ofRj� Q s` . o 00 .'Q� Re-Occ $60.00 Notary $5.00_ Total_____ _.