REOCC-04-24-807Miami Shores Village - BUILDING DEPARTMENT a!VED
10050 NE 2 Ave Miami Shores, FL 33138 Ai'R 0 3 2924
305-795-2204 www.msvfLgov
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RE -OCCUPANCY APPLICATION ////
Permit No. REOCC- W_ _Li/ - % I7
Contact Name: TP-('1 � k"_FANNA10t11 Phone#: G/�3>ZZD�9DDD
Buyer: r� 1-gIIA/ I �/�(
M (30PL4 OW Seller: P&O l(1011t ��� k T�1[AUfI �6S�fm-lN�
Realtor: Wix P-e��c� Company Name: &RIP 1
Property Address: q6( N,5
City: Miami Shores State: Florida Zip: J
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. In addition, I acknowledge the requirement
for a swimming pool barrier to be in place and in compliance with code requirements at the time the pool was
constructed, repair and or re -surface.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
Signature:
The foregoing' trument was acknowledged before me this
A day of�,20 4 ,by TkiAl14 \KONSIAA/ _IINfJV
who is personally known to me o who has dp oror ed`436 Cot k2r4¢!s , L As identification and who did take an oath.
•"• • ;:;�y".v "ayo. KRISTINE KEPPLE YAO
z° • Lr': Notary Public - State of Florida
Sign: ��— ' ''� ission K HH 152227 RE-Occ: $60.00
'�..., or h V my CommComm. Expires Oct S, 2027
Print: ` nded through National Notary Assn,
U� 7
My Commission Expires: Total: -Q.
Building Officials Approval: tra OS A
(REV 4-10/07192023i.Nv Re -occupancy Application Page 1 of 1