REOCC-03-24-692MAR 2 0 2D24
1
RE -OCCUPANCY
APPLICATION
Contact Name
Miami Shares 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
Carrie Copeland
Buyer: Ted L. Kretschmar
Realtor: William Hodges
Permit No. PCOet, - 63 ZN - toy Z
,ter'
Phone#: 305-206-8410
Seller: John Copeland, Carrie Copeland
Company Name: McB Realty Group LLC
Property Address: 240 NE 97 STREET
City: Miami Shores State: Florida zip: 33138
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: Carrie
Signature:
2
The foregoing instrument was acknowledged before me this
day of*�, 20-1) by &4, 1
who is personally known to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign ,Y.�... —
'' h" Notary Public - State or 'l
Print: y ._? - orida
`oF My Comm. Expires ,Mar 6, 2022
My Commission Expires: �� 3onced through National Notary Assn.
Building Officials Approval:
�i 3 ?(
REV 4-10
Re-Occ $60.00
Notary $5.00
Total