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Re-Occupancy Application REOCC-02-23-346-is, sose COM41221014 A Hit USSOO, WELMME CHIELA RE -OCCUPANCY APPLICATION 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 Permit No. ENfflrnftZD BY: FEB 0 g M3 Contact Name: Gr V�', S P\N A C Phone#: 3 US - -2 Buyer: ASti L( C Seller: Realtor: arLt; s R ^ c < Company Name: � Y) G C_ G 10 �4g_c <� t / Property Address: ©6 } D N E � o p U �� City: Miami Shores State: Florida Zip: n� 3 k %'� 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. r Applicant Signature: The foregoing instrument was acknowledged before me this `�1 day of F2l%y SGl l� S I V t� y�, who is y ]mown to me or who has producedL Vl TIMC As identification and who did take an oath NOTARY PUBLIC: Sign: I�i/l L/)7 Print: I `� e/I Iry My Commission Expires: Building Officials MERLINE CHERY MY COMMISSION # HH 262206 EXPIRES: April 12, 2026 Re-Occ $60.00 Notary $5.00 i outt a �' ��� REV 4-10