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Re-Occupancy Application REOCC-11-22-2845RE -OCCUPANCY APPLICATION Contact Name: Buyer: Realtor: d ane Property Address: 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 ee dcc ^ t i - Z2 -- 20 q S Seller: Name: 19©n r City: Miami Shores State: Florida Zip: � 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 Name: Signature: `� The foregoing infl day of N�Q who is personally known to me or who has produced rL-- ��1%3 As identification and who did take an oath NOTARY PUBLIC: Sign: Vivi8nneY80 4A��'pr Comm.0 222410 Print: l V -e—"\. a-p Expires: Jan. 31, 2026 M Commission Expires: (` 3 0o Z- '%�''i�•••''�•` . Y P %,,,1�OF f011 Notary Public State of Florida Building Officials Approval: Re-Occ $60.00 Notary $ Total $ (0 0. c"' REV 4-10