REOCC -04-24-1057Miami Shores Village 0
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 Permit No.
Contact Name: I k^ /y c r Phhpone#: bus JvS /YS7
Buyer: fl c{ V� (cI..i. Seller: Sfe'O L PC / c c, s 1 Sc �`S�a�✓�
Realtor: Company Name:
Property Address: 90 NE 91 Sfr'Zt—
City: Miami Shores State: Florida Zip: 33 13 O
I hereby certifythat 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 nstrument was acknowledged before me this cl
day of Qa l .20` f , by ST,^ Pe-fl'cc
11.who is personally known to me �rvGFo has pro uc � off, aA
( , c- As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print: V i, Sf-i 0E K. 7 K -7-
My Commission Expires: 10I8rd�Da7
KRISTINE KEPPLE YAC
Notary Public -State of Florida
Commissionif HH 452227
n. My Comm. Expires Oct 8, 2027
9onded through National Notary Assn.
:7
Building Officials Approval:
RE-Occ: $60.00
Notary: $5.00-
Total• � L -