Re-Occupancy Application REOCC-02-23-299�b 1_,;3
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RE-OCCUPANCY
APPLICATION
Contact Name:
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
ZI3 I2�z�
Permit No. Vf&XL Z3 - 2-9 r
Buyer: r LCV6. 3,A.tL `I 6 E Seller: `1) nv I (+= E�1- n n r_yr
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Realtor: Company Name: --t)a—R E-A-c 7,,,,L
Property Address:17L1 r\1 E l O b �9lLF�P7
City: Miami Shores State: Florida Zip: 3 3i 3,?
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 foregoing instrument was acknowledged
me this 4—
day of F- 1-v--20'�.i by 4 &4 ;
who is FConally k'no to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: a..,
Print: 40
My Commission Expires: j,-a „ y A
aoa.3-
Building Officials Approval:
REV 4-10
LISA CHRISTINA FLORES
Notary public • State of Florida
Commission k HH 318549
Ay Comm. Expires Jan 28, 2027
A through National Notary Assn.
.4yv"oy,, LISA CHRISTINA FLORES
Notary public - State of Florida
Commission g GG 286706
My Comm. Expires Jan 29, 2023
8ondad through National Notary Assn.
Re-Occ $60.00
Notary S&W
Total $ 60-co