Re-Occupancy Application REOCC-03-23-554Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
y Tel: (305) 795.2204 Fax: (305) 756.8972
Y INSPECTION'S PHONE NUMBER: (305) 762A949
RE -OCCUPANCY Permit No. t-0 L0, 63-Z3-SCM
APPLICATION
Contact Name: ;?0T6tjA C$VPLAQa£.& Phone#: tea- (eeyi1-142h
Buyer: ASi-+-`li 1(f+ Gt p0N€W AQD�N>; Seller: Kow 41 4-tOU tR It L.lc n
Realtor: t?On,Nq C�AtA3E�1t Company Name: Duo &tOSAl R.eAL2-Sibi�6ecO
Property Address: 301JP- CR -& C(O trk,bm% SttoQA;
City: Miami Shores State: Florida zip: 3 3 138
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:
Signature:
The foregoin ent was acknowledged before me this
day of `o`-'—, 20a by _E91M/1A 1
who is personally known to me or who has produced
lf& 179 As identification and who did take an oath
NOTARY
Sign: b Z
Print:
My Commission Expires:
Building Officials Approval:
REV 4-10
VINOANELAVRE2
AM NOTARYKJOuO
STATE Of NEVAU
APPT. NO.22-9527.01
1W APPT. E1MS OCTOBER 10, 2M
Re-Occ $60.00
Notary ® • 00
Totals U 0 . ad