REOCC-09-23-2294 383 NE 96 StRE -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
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Permit No. ? _ 2 Z
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Contact Name: i - Phone#: ' 2G
Buyer: orcj)y &4'-) yu, 1%Gy'� A"CK �- q MQk
Realtor: (5'C [ V C �L Company Name:le OVV\ r,eo
Property Address:_
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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 line: 6�fAa fy\'C'f 0 ' I P(\t�wV1/ V / J x"_
The foregoing instrument was acknowledged before me this
day of 5f J ✓20 �LSby
who is personally known tom r who has produced
As identification and who did take an oath
NOTAR/Y�PUBL
Sign: ��'/
Print:
My Commission Expires:
BILLY CASIM:of
�`„ Notary ?ublic StateFlorida+�7a;Commission 4 HH574
oc R°My Comm, Expires M, 20Building Officials Approvona Nry Assn.
Re-Occ $60.00
Notary $5.00
Total
REV 4-10