REOCC-09-24-2425Miami 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
RE -OCCUPANCY APPLICATION
Contact Name:
Permit No. A 6oeC - d5 - Z 4 -Zy L S
r
Buyer: MAkketkl k0h+an Pr,rweNjE, 5v§eller: CyiS 'F,iP Wy-es'k- Covf
Yy
Realtor:bS Mo Ldt KA Company Name: AaVC. A"e ilea Cue
Property Address: LOI 14 W 10je+j ST `ter
City: Miami Shores State: Florida zip: 3 3 ISO
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
,l l^ \osl_, ca
Signature:
The foregoing instrument was acknowledged before me
day of 5-R.F-k- 20Z by Uay-pvj /Ay 55 ad
who is personally known to me or who has produced
L L-As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials
(REV 4-10/071
Vivienne yao
Comm.:HH 222410
Expires: Jan. 31, 2026
Notary Public. State of Florida
IV EID
n ')ipplicatioll
SEP 18 ZOZ4
BY:
RE-Occ: $60.00
Notary: $W
Total:
Rage 1 of 1