Re-Occupancy Application REOCC-03-23-750y`r�
J:1] 'L .'
/4' �v� tiZ' 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
RE -OCCUPANCY Permit No.?ZCY C-C3
APPLICATION
Contact Name: J % SA P-04(1-6 s Phone#• '7 66 ` 3_o S - a-W-1i
Buyer: 04-A-D tZ�Ns4 -1-LVrJc97E At-) Seller: ZF-IFW'EV S
Realtor: 1:1 S Gt- Q-�E 5. Company Name: i0-
Property Address: �6 U " w i I2 Srl
City: Miami Shores State: Florida Zip: 33Wz
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 befoiAme this" OL-
day of s'nt ct , 20 23; by f s ' �k • L . A � �{
who i onally known o me or who has produced
"-- As identification and who did take an oath
NOTARY PUBLIC:
Sign: �&, , c- ,
Print: L. S o` c % �:,s� ,-., ,
My Commission Expires: -U-4 i
Building Officials
REV 4-10
a 9 ) d.da-)
..i"' ..
AMR Y;`;
y®<'
LISA CHRISTINA FLORES
Notary Public - State of Florida
Commission 8 HH 318549
'?er F.d!�'
My Comm. Expires Jan 28, 2027
��� Banded through National Notary Assn.
Re-Occ $60.00
Notary $5a®0
Total $ L' _ c'