Re-Occupancy Application REOCC-12-22-3110_001\��a\tiZ 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
APPLICATION
Contact Name: Robert Bourne
Permit No. eCOW - 12-ZZ-31 Iv
786-281-8376
Buyer: L op_ J 4:=L 6t - Seller: � /,j l 4 e P
Realtor: Robert J. Bourne Company Name: RBRE
Property Address: k,:t S t n d l O
City: Miami Shores State: Florida Zip: ( 3
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 Hamer&*ert J. Bourne
Signature.- _ ._aft
The foregoing i�nsstrruume2 vas ac wle -ed befo this _
day of IZ_YF-v"20�`tiy le M�
wh - -� nown m— mr who has produced
As identifi lion and who did take an oath
My
MY COMMISSION $ HH 109171
EXPIRES: June 17, 2025
Bonded Thru Notary Pubk Underwriters
Building Officials
REV 4-10
Re-Oce $60.00
Notary $5:06
Total $