REOCC-04-24-1044Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
RE —OCCUPANCY APPLICATION
Permit No. REOCC-
Contact Name: I'IYIcn f I rwt T'_)
Buyer: �'o f c n {ie f hSeller
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Realtor: �n nj Pe,'A! CompanyName:
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Property Address: :IAU AlE ou r`, SikeQT
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. 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 Name: �. 116�
Signature:
The forego' rument was acknowledged before me this
2q-dayof r2024 by Pev'c'kS
who is personally known to me or who has produced ` ✓ cy (-1 � As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: V L V l -e-yl ✓\� a,
My Commission Expires: ' (3 i ) Z" Z,1n
Building Officials Approval:
05 0/ 14/
(REV 4-10/071420231.N R -occupancy Application
RE-Occ: $60.00
Notary: $5.00
Total: is 5 , cr'
iRT — ��.RED
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