Re-Occupancy Application REOCC-01-23-137Miami Shores Village
Iz� 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
RE -OCCUPANCY Permit NoRC-6 -`e -a - Z3 - (3-7
APPLICATION
Contact Name: A s & -
PhoneP#:
Buyer:2ae- ALoBSbc° ZIK iac_ eler: 6-3.
Realtor: AsramL 3f8S 0 rr , � Company Name:
Property
f4
City: Miami Shores State: Florida Zip: 33 13 S'
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: J 'S "`_cs� 'S 0GL, �
Signature:
The for instrument was acknowledged before me this
day e, 2013 by /�Shrc i Soh;
who is personally known to me or who has s pied e1-
�{ �y -e.- As identification and who did take an oath
NOTARY PUBLIC
Sign:
\ I aWuunry
Print: �/ 1 V C-L-
My Commission Expires:
Building Officials Approval:
Vivienne Yao
Comm.:HH 222410
Expires: Jan. 31, 2026
Notary Public - State of Florida
Re-Occ$60.00
Notary $5.00
Total
411MAE111MI