Re-Occupancy Application REOCC-11-22-2861RE -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) 762A949
Permit No. J ` t OCC - 1 t - ?� - 28G, t
Contact Name: L t'_ `f r A) rt2)yA R n�5 Phone#: i5- `7 10 3 3 b�
Buyer: r(' A 1 & oJesTlnr i 1 S U(,Seller: Yv)A(7_ k 4- Mai,./ I_, c,�_-g A od
Realtor: i'` L- 0 'j QA e_, S Company Name: OyO L ' 66TA " b�Ken 61,
Property Address: 1ik 4J q— � O V 421-
City: Miami Shores State: Florida zip: �1 13
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
Signature:
The foregoing instrument was acknowledged before me this U
day ofNE� tm6f() 22-by lejZV�n (3Ur/15
who is personally known to me or who has produced Fq-
iy'Qx s L,'r- As identification and who did take an oath
NOTARY PUBLIC:
Sign: () -� LJ(°R-U
Print v t sf i zV-x n-c_
CL �
My Commission Expires:
0W. Pll!, VivienneYao
a�!:••••• :B�
_p n Comm.:HH222410
sy Expires: Jan. 31, 2026
��n°�na"`�� Notary Public -State of Florida
Building OfticialsApproval:
Re-Occ $60.00
Notary -
Total $ Go •fo
REV 4-10