REOCC-08-24-2121Miami Shores Village-13UILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www,msvfl ov
RE -OCCUPANCY APPLICATION
Permit No, REOCC- Cv'-Zy-2aZ t
Contact Name: v
Buyer: � Phone#:_
Seller:
Realtor: r
s Property Address: 'Z Company Name:�-
City: Miami Shores State:
Florida Zip:
I hereby certify that I understand that the zoning for this property is for singe -family residential use and that it
11 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 Na r'-
Signature:
The foregoing losta nt was acknowledged befo
day of — this
who ersonally kn n to me o who has Produced
pt ^ As Identification and who did take an oath.
NOTARYVUBOG
My Commission
Building Officials
(REU y 0 !t
KERRY DIAZ
MY COMMISSION # HH 109171
r
RE-Occ: $60.Oo
Notary:.$#gg-.
Total: (D O • !x7
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