REOCC-24-1306Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138 I24 12�
305-795-2204 www.msvfl.gov
RE -OCCUPANCY APPLICATION V
Permit No. REOCC� I' I�
Contact Name: h l L C'KCW G ' M Phone#: / K 6L1 Q2—n5�-C
Buyer: Seller: l Yl 15, In G A,"1
Realtor: IKiCKiM—Company Name:
Property Address:
City: Miami Shores State: Florida zip: �5
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: ` ' s _k` j ::!' �,AkAtr �
The fore instrument was acknowledged before me this
Zy day of Ir 20 7"-f by
who is personally known to la or who has produced K L���-'•�• As identification and who did take an oath.
NOTARY PUB C:
Sign: 'ussr�'!eso� !euopen 45naVt paouoA,,,,,,,, RE-Oee: $60.00
eo3`..
;..g, �� _ aoisuwwo� Notary: 5.00
Print: ... i,y ' �:); ry� $
My Commission Expires: - 1, 1 . S!^'14y Total:
Building Officials Approval: / JJ
(REV 4-10/071520231.i ke-occupancy Application Page 1 of 1