Re-Occupancy Application REOCC-10-22-2726_ v�.�:-av-. z+•esra�-�•.+e%�,+r4r�cstic.::== a��=-�sr
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RE -OCCUPANCY
APPLICATION
Miami 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
Permit No. -- W Z .6
Contact Name: 1-0 15 c�'e 'D t 1 Ve Phone#: % P6 cl u a
Buyer: Gk, Seller: i- 1Z I ell
Realtor: D I S c�2 D P I Y¢ t iZ-� Company Name: u4I
Property Address: 1 -37 6 n E. 100 +-K S+�
City: Miami Shores State: Florida Zip: �3 3
I hereby ceitify 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 issn-d 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 AF_ 1DAVIT: I certify that all the foregoing information is accurate.
Applicant Name:, / L�', 5 _ . v �I Y-R i a . —
SignaCrre•
The foregoing
instrument was acknowledged before me
thiiss
day of W+ '202rby L MS 90e VIth�IIW—(C,"
who is personally known to me or who has produced
cj► C!J�� As identification and who did take an oath
NOTARY PUBLIC:
Sign: Ir I I V�1 Y411 �Y -
Print:
My Commis:., a Expires:
Building Officials
MERLINE CHERY
MY COMMISSION # HH 252206
EXPIRES: April 12, 2026
Re-Occ $60.00
Notary
Total $ U V
Ri V 44C