REOCC-09-24-2401Miami 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
Permit No. kcfxt -m 4 `' 40 J
Contact Name: MW6 LOWM01/1 Phone#: IV,
, ��62
Buyer: f '&&CJ f I ' I i G d e Ler)C�JA� Seller: TO 61 �' R"k --
Realtor: ran Lv j �A Company Name: Con9vJosl 1— lo,,; 0 L LC
n .
Property Address:
`110 4 N t y Avc,
City: Miami Shores
State: Florida
ip: 3 )3
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 I
Signature:
The fore oing instrument was acknowledged before me this1 16
day of 20 _2, by JTO w ' A
/� who is personally known to me or who has produced NIA
As identification and who e an oath
NOTARY PU IC:
Sign:
Print:
My Commission Expires: `�s` "R'?Pua?MARCI LO1*114
J *°� n ti f,°� Commission i� NP114327.6
Expires July 9, 2025
ServlcO
F�- F'�o�` BundcufhiuBudgelNalary
Building Officials Approval:
*V 4-10/0-/1920231 o cupancy Application
RE-Occ: $60.00
Notary: $5.00
Total:
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