REOCC-06-23-1431 54 NE 102 StMiami 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
RE -OCCUPANCY
APPLICATION
Contact Name: V641z��6_11
Buyer: l LA &d
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''-- Seller:
VVl1
Realtor:
Property Address:
City: Miami Shores
y Name:
Permit No.
Phone#:
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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
Applicant Name
that all the foregoing information is accurate.
Signature: / l/
The foregoing instrument was acknowledged bef re me this
day of_� i� , 212a, by xxc V . c�
who is personally known to me or who has produced
�L As i ent'f'cation and who did take an oath
NOTARY PUBLIC: HEBERTMARTINEZ
Sign: f W COMMISSION# HH 323276
EXPIRES: OCIDWr 18, 2026
Print: (W-
My Commission Expires: A
Building Officials Approval:
Re-Occ $60.00
N ota rA5-60-''
Total $ (Qc.CD
REV 4-10