Re-Occupancy Application REOCC-02-23-377Miami Shores Village
") ,Building Department
nn..__10050 N.E.2nd Avenue, Miami Shores, Florida 33138
\'L7 Tel: (305) 795.2204 Fax: (305) 756.8972
\,� \ INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No. ^ C�CC-62.-2-�' 37,
APPLICATION
Contact Name: � Phoneri�:-¢�
Buyer: Seller:
Realtor: CompanyName:
Property Address: � 1
City: Miami Shores State: Florida Zip: -:�Z,
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 i-3
day of ,2023 by VO-heG s; M�9
who is personally known to me or who has produced
L.C' —
�' 'V e v 5 As identification and who did take an oath
l,c•Yr_uul��
Sign: � J
Print: V % d I y OLD
My Commission Expires:
Building Officials Approval
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o#00 IN
Vivienneyao
Comm.:HH222410
Expires: Jan.31,2026
O��„`�'
Notary Public -State of Florida
Re-Occ $60.00
Notary
Total $ (aO.Cc�'
REV 4-10