REOCC-04-24-997RE -OCCUPANCY
APPLICATION
Contact Name:
Miami Shores Village
Building Department U'L02
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756,8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.
Buyer: l h'itAA te�C ( iLArjy-- for 1 Seller: EcA 1 ,his �,C( S 2-1 �Q j
Realtor: �1tS�Cc� 1 ����jn Company Name: Val"' ekA kayL 21ec ►�
Property Address:
City: Miami Shores State: Florida zip:_3�J1�0
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: �"'� v S
Signature: , A b
The foregoing instrument was acknowledged before me this it.0
day of by��f14
wh is perso 0 me or who has produced
As identification and who did take an oath
NOTARY P BLIC:
Sign: �� . TAMMY J. GELLER
Print: 'vi yq�,p •` MY COMM ISS ION # HH 485008
r�y�e-/� %o..•;aP' EXPIRES: December 7,2027
My Commission Expires: � 1O — lJ'�i -a � Ff�•
Building Officials Approval:
2.6 Zy
Re-Occ $60.00
Notary $5-,
Total $ nn VG
REV 4-10