Re-Occupancy Application REOCC-04-23-910RE -OCCUPANCY
APPLICATION
Miami Shores Village
Building Department
100SO 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. �CQ �C - Z 3. �' C?
Contact Name: 6$C- r2- Si$ Id G(0- Phone#: 3o7- 9 9 -31 s (
Buyer: .j¢SS cro Son- �Dee S Seller: Morc.o V,�Inz!iucZk Mo�kw V ci t�
Realtor: CiF-S pv-L- O : In. Pto ( Company Name: Vt^ % �-cA_ k eu /If Grb
Property Address: l- S N W tog -5 -Y /-t ; n — S L') ✓� s. 3 3 I (,
City: Miami Shores State: Florida Zip: 3 3 1
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: CFSe r
Signature:
(Lr
The foregoing �ment was acknowledged before me this
day of (Ct L 20 ?� , by GIB-$ / r, Z
who is personally known to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: f3-31ttlERY�
Print:•? c,� 1.1Y COMMISSION#GG 950477
March 0,2024
•O !:• Bonded Thru No(a Public Underwriters
My Commission Expires: —.ry
Building Officials
Re-Occ $60.00
Notary $5.00
Total 5 6 N . o
REV 4-10