Re-Occupancy Application REOCC-11-22-2957J.
i.
ENTF,RE,
Miami Shores Village Tr
tlnv 21 20 2
BY:
RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer:
Realtor:
Building Department NOV
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795.2204 Fax: (305) 756.8972
ION'S PHONE NUMBER: (305) 762.4949
fn� v
Permit No.
(2
Property Address: &4�
E 2�5_ :5;
e�T
City: Miami Shores
State:
Florida
Zip: 3 3/
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 foreggol.n4 Instrument was ackholdledged Je c a me this Z1
day of L 1� . 20 � by MCA n SO � J rdlA�. 4 rc✓
who is personally known tome or who has produced, Dy, Ve✓
tAs identification and who did take an oath
Sign:
Print:
My Commission Expires:
Building Officials
MERUNE CHERY
w COMMISSION A HH 252206
EXPIRES: April iZ 2026
If Q
Re-Occ $60.00
Notary�
Total $ LO D ' Q)
REV 4-10