Re-Occupancy Application REOC-04-23-857i�wrw�wus_aeysnwS�wa tua.c��.�af't`aen_waN+.ra ,a
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RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer: '/ n
Realtor:
Property Address: ��r9
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. Q4 - G 3 97
Seller: Ter&S/-A � ��
Company Name:
City: Miami Shores State: Florida Zip: 3-3I i %
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: t ` re_<;� r—
The foregoing instrument was acknowledged before me this
dayof o d ,200 by 7�« �(t)gCeF
who is personally known to me or who has produced
As iden ifie * and who did take an oath
NOTARY PUBLIC:
Sign: Y(( 'C.
Print:"`
A % HESERTMARTINEZ
My Commission Expires: p MY COMMISSION # HH 323276
' ofiyn�i EXPIRES: October 18, 2026
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10