Re-Occupancy Application REOCC-03-23-812RE -OCCUPANCY
NEami 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) 762A949
Permit No. t(0�03-23 _ "12
APPLICATION
Contact Name:
Buyer: _
Realt4:
Property
Seller: W CID n CQGD
_Com any Name: Wit`
f L7
City: Miami Shores State: Florida ZIP:
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 AF'FIDANIT: I certify that all the
Applicant Name: .—.
Signature*
The for oing instrument was ac Iedgedbeforemeti's
who as er Dually Imown h has produced
As identificatign and who slid take an oath
yr COMMISSION # HH 109171
My Commission pines: _+, . p c EXPIRES: June 17, 2025
Building Officials Approval:
affa-WAM0+
is accurate.
Re-Oce $60 00
Notary $5 00
Total $