Re-Occupancy Application REOCC-02-23-305Miami Shores Village
uL-11-
AS\
RE-OCCUPANCY
Contact Name:
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
Permit No.`02 -n—
Buyer: f t Seller: �yu1 K, P-ay D Di4r ti,
Realtor: �'YYUGu �Atwvok'&tz Company Name: (AO rL& &.Q LS-r-C, �&afKA
Property Address: I I iS;5_ NC 104 S i ! { C"t ; i Sk'D rLeC,;.1 FL
City: Miami Shores State: Florida zip: -3313'5
omat's ,h Cu) beLIsot I n. ni
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 foreg ' trument was acknowledged be ore me this '3
day o 20Z by OMatha LnDtJX2,.
who is personally known tome or who has produced L 1.-
As ide tific ion an� who did take an oath
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
.;; .....
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276
6
Re-Occ $60.00
Notary $5.00
Total $ �9�•°°
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