Re-Occupancy Application REOCC-03-23-810Miami. Shores Village
Building Department
10050 ME.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fox: (305) 756.9972
INSPECTIOYS PHONE NUMBER' (305) 762.4949
RE -OCCUPANCY
APPLICATION
ContactNamep
Buyer• r o�rt—
Company Name:
Permit No. P�a�,_Cq 4 1Z C
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Property Address: — —
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 AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name•
Signature: ..�yy
The fore oing instrument was aclm ledged Wore me 's,2L
dayo�i
who is pet nl� lv lmowa to r who has produced
As identification and who did take an oath
NOT
Sign:
Print:
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Building officials Approval:
Re.Occ $60.00
Notary $500
Total
REV 4-10