Re-Occupancy Application REOCC-11-22-2992Miami Shores Village
e \-� Building Department
..� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
t' INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No. k_WC-t�`ZZ-ZRa2-
APPLICATION
Contact Name: Ijes Phone#: 30S.-7"]0,353
Buyer: ?0 610 CCJ.'S+O Seller: (Joy �S/e.
Realtor: W-e-5 �1�`T Company Name:
Property Address: " 13 (a, �I1/J O� C �Q - '_3r_
City: Miami Shores State: Florida Zip: (!�Z; C)
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
C. T-e(is
Signature:
The foregoing instrument was acknowledged before me this 2
day of �) rri� � . 20 2L by WO -AZ
who is personally known to me or who has produced
As iderltifica�ion end who did take an oath
NOTARY PUBLIC:
Sign:
Print: ttelblcm % t,M
My Commission Expires:
Building Officials Approval:
HEBERT MARTINEZ
MY COMMISSION N HH 323276
EXPIRES: OcloW 18, 2026
Re-Occ $60.00
Notary,$5'00
Total
REV 4-10