REOCC-05-24-1200Miami Shores Village - BUILDING DEPARTMENT kA5e- cat,(,
10050 NE 2 Ave Miami Shores, FL 33138 30 M I r.1 kloj> io
305-795-2204 www.msvfl.gov
RE -OCCUPANCY APPLICATION 31
Permit No. REOCC- 0S— 1�4 ` U-00
Contact Name: &S a Caro, go'L r 1 Phone#: 3- ! CS ' JL
Buyer:M --rr,, �G1" 11b C/d�tsl� Seller: v� d
Realtor: ��GNYYffi �, A Company Name
Property Address:��—
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
Signature:
The foregoing instrument was acknowledged before me this /1
15- dayofM&I 20ILL by rKE1NatP' l A� 010J �OR,1A
who is personally known to me oyun o as pro V-t
ed o :bj,�JL C_ As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials
(REV 4-10/071920231.N)
a., KRISTINE KEPPLE YAO
�L.
Notary Public - State of Florida
` commission # HH 452227
y Comm. Expires Oct 8, 2027
Bonded through National Notary Assn.
Zy
spancy Application
RE-Occ: $60.00
NXaW"*4Q& 0
Total: fa b