REOCC-07-24-1899Miami Shores Village
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
� 001[
APPLICATION
Contact NamelI: �oyt,15 IA SareV -u l�k
Buyer: Ca lr(05 '4eyl rl que- (& I 6 Seller:
Realtor: 1c, yl VIGt ) f N`n Company Name:
Property Address:
WaliQ j4esiaS
305% Zq I-. 3z) 0
Permit No. Eoe2-O7-2q-1 oqq
City: Miami Shores State: Florida Zip:"�3190
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
Signature
The foregoing instrument was acknowledged before me this Jam
day of _TV�r
1204by IVicyy\ci,:'n,
who is personally known to me or who has produced �Ot \Ciq
1'W01I" `S As identification and who did take an oath
C[xY fit_
NOTARY P,ll-BLI
Sign: 1 ,
Print: "Odt4)7V� IUVIL-ls � r4nl/!7e
h o� My Commission Expires: mam/ ZD2
Building Officials Approval:
YZI/Z_1
REV 4-10
OFFICIAL STAMP
MAOYLINMONROE
NOTARY PUBLICUBLIC - OREGON
COMMISSION NO. 1034649
*MY
COMMISSION EXPIRES MARCH 06, 7077
Re-Occ $60.00
Notary $ -0
Total $
JUL 23 ENT