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REOCC-09-24-2308Miami Shores Village RE -OCCUPANCY APPLICATION Contact Name: 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. 12— t C7 CCU Vq - z`I' Z3c�e v c,.+:. tN I cs.n c) a-vo �l e5 l--,6ro ve,rtz �(7L� i �tC�. �' 4.�1 0 � Buyer: Seller: Realtor: ©mil U�o.,ke� CompanyName:(Sknrx �P�k tz��)xt L-L-C- Property Address: aTC( L} City: Miami Shores State: Florida Zip: 3'31 .3 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 Name: Signature IA — The foregoing instrument was acknowledged before me this JD day of , 20 , by PCi 4Y;C1c-_ .4rc who is rr rally known to who has produced As identification and who did take an oath NOTARY �PUBLIC: Sign: Print: K0_' j�'W My Commission Expires: Building Officials Approva . U90�Z/ KATHRYN ANNE BLAKEMAN Notary Public • State of Florida mac: Commission # HH 2O7396 OF vV ' .My Comm. Expires Dec 14, 2025 3orded through National Notary Assn. Re-Occ $60.00 Notary $5.00 Total $ REV 4-10