Re-Occupancy Application REOCC-12-22-3233Miami Shores Village &69)fMCT Ilg
Building Department���1 e
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No. (;�eoee -12 - Zz - 3z33
APPLICATION
. ) A tinbL�
Contact Name: iltilVY�ICiC 1 J ��II� (l_ IJJn � Phone#: 7 o 33 - 97 --3/�Z
Buyer: �2 �p / Seller: A i (( �(n;(3 CT?�
Realtor: �Oell�:S 1 (q�� Comyp� any Name: 11C5�irY 1176131 �tY7 ( i ii 14
Property Address: ! L) (,Oi� i il> ITb�i 2
City: Miami Shores State: Florida Zip: / �J
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
day ofndf'202z , by Caua.b e_f l - r'J 4
who is personally known to me or who has produced r-'C-
1 i/-6y3 As identification and --who take an oath
NOTARY PUBLIC:
Sign: U
Print: V L V �n.� \f
y�W �""""�rf Vivienne YaO
My Commission Expires:Comm.:HH222410
_.:�,tl'.'` Expires: Jan.31,2026
aP� HotaryPublie- stateofFlorida
Building Officials Approval: Re-OCc $60.00
Notary $5-.00-
Total $ `
REV 4-10