REOCC-11-24-2833Miami 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. L'-tOCG— l l-2-q-2 '33
_ off- 305) 331 - (,JL4 S
Contact Name:
vlk e l l (Sty � c r V1 Phenetk .3 02-
Buyer: 1` << �`�� d ���1 GIArO-2 Seller: C�A� AS �R Ye✓IS
Realtor: D4u rt1 FA � 0 Company Name: G!�j "ev,KeS f1eg N-orS
Property Address: 0 Lis? N E 6M+L'g V ee_t
City: Miami Shores State: Florida zip: 33i7A_
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
ignature:
he fore(gooing instrument was acknowledged before me this _
day of �rd -202-Y by Gill * $1!t'VG�S
who is ersonally known me or who has produced
NOTARY PUBLIC:
Sign: &'AZ' ^'
Print: �-'`-k1_
As identification and who did take an oath
. 2. iwk_
My Commission Expires:
osc
Building Officials Approval:
it J �y
RE-Occ: $60.00
CLARA R. PINK Notary: $5.00
W COMMISSION # HH 485260
EXPIRES: February 18, 2028 1 Total:
occupancy Applica�jon