REOCC-07-24-1995RE -OCCUPANCY
APPLICATION
ZPA or:
Contact Name:
Buyer:
Realtor:
Miami 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
Permit No. w
61-++n er +�ane--�:: 365 -`7(0- 37o4
Phone#:'',3F1-216 -'312.0
Seller: 2azy1i4e,
Company Name: Mfr f ► r diffeAf
v qC--- Property Address: �� UT.
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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
Signature:
The foregoing instrument acTc Me Meted efore me this ,
...,
day of 1I 20 , by V�.-7 e:L "2
who is personally known to me or who has produced
As fication and who did take an oath
ident'
NOTARY PUBLIC: C�
Sign:
Print:
My Commission Expires:
Building Officials Approva
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10