Re-Occupancy Application REOCC-02-23-271Miami Shores Village
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Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30S) 762.4949
RE -OCCUPANCY
APPLICATION
F/o r CIL r solo � o
1� r
Contact Name:
Permit No. P_E(06L-42—Z3-Z-7j
y2,O- o 2
--86-3lZ- 51--o
Buyer: /< i r la a e /d t f e ct *a- Seller: FI C01- 41"�' S o l o� 0
Realtor: M 0k'1 I C cA �_(Iil n fqZ" —CompanyName: 2 Es F
Property Address: + N ' 9 5 Tamer f
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: 1 certify that all the foregoing information is accurate.
Applicant Name: W) R_ C 2( S o Z, O E
Signature:
The foregoing instrument was acknowledged b fore me this
day of r-el ru 20 _z-3 by alb r- el Cl c^
who is personally known to me or who has produced /:;L
�'V -Grr L. L. As identification and --who take an oath
NOTARY PUBLIC:
Sign:``."PY!Q" Vivienneyao
r�r Comm.:HH22241
Print:_���Jt 2 ty1'— i4 0 ':`
II yy, �,''��' Expires: Jan, 31,2026
My Commission Expires: I 131 lZOZ6 °o,''dir �.� Notary Public• State of Florida
renma
Building Officials Approval: � I —/23
Re-Occ $60.00
Notary *@ i
Total $ G o . cn
REV 4-10