Re-Occupancy Application REOCC-12-22-3038RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer: (71QCG
Realtor:
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.ca6u -1q -Z7— 3\ 3 �r
S e7t26trC1 CiVGtYLi� Phone#: 196- qF) -fl 01 (
Property Address: 210 N) W TOSS l -
City: Miami Shores State:
Seller: C-8041?-co X A)0+0
Company Name:
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: 7[-6!o tsr"' °ram
Signature:
The foregoin Instrument was acknowledged before me this
day of 20Z2 by
who is personally known to me or who has produced
NOTARY PUBLII
Sign:
Print:
My Commission E
Building Officials
REV 4-10
As identification and who did take an oath
ARLENIS SILVERA
EXPIRES: March 6, 2024
,d Thru Nolm Public Underwdtem
Re-Occ $60.00
Notary $5.00
Total $ U 5• o'--'