Re-Occupancy Application REOCC-02-23-448'16
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. %'�
923�
Contact Name: 2—
Buyer: i_G�� �?:> Seller.
Realtor: )�� �- � �t ` 6) Company Name•
Property
City: Mani Shores State: Florida ZIP:
ML
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 -
The fore g instrument WasWAm9wledged bsfe;eyne thisa
day of by i fi )
who . onall or who has produced
As identification and who did take an oath
My
MY COMMISSION N HH 109111
EXPIRES: June 17, 2025
Bonded Thru Notary Public Underwillers
Building Offidais
REV 4-10
Re-Occ $60.000
Total .$9�