Re-Occupancy Application REOCC-01-23-82_001d fJSY}Y "'r AiIH� yyyyyy
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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
RE -OCCUPANCY Permit No.
APPLICATIO
6
Contact N me.Phom
Buyer: Seller:
Realtor: Company Name:
Property Address: • -/
ENTERED
JAN 12 2023
BY: J "
City: Miami Shores State: Florida Zip:
-S-KO\4- 0-
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
Signature:
The foregoing instrument was acknowledged before me this/�22—
dayof�,20�3,by llsgf& Vanews l�C&qjl
who is personally known to me or who has produced
`fuDa • As iden¢ficp' nn and take an oath
NOTARY PUBLIC: 1111
Sign:
Print:
My Commission Expires:
Building Officials
REV 4-10
HEBERT WRTINEZ
MY COMMISSION # HH 323276
EXPIRES: October 18, 2026
Re-Occ $60.00
Notary$"0
Total $ (QC)'