Re-Occupancy Applicattion REOCC-03-23-811Miami Shores Village
uiiding Department
1050T i(3 5) 795 2204 Faxr: (05) 756 9972Shores, Florida 33138
INSPECTION'S PRONE NUMBER: (305) 762.4949
I'ernr6t No.
APPLICATION
Contac
Buyer:
Realtoi
Property Address: ' LO
City: Miami Shores State: Florida Zip:
' .-761
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
that the referenced property is being used for single family
may be issued by Miami Shores Village certifies only
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 AI'MAVIT: d certify that an the foregoing information is accurate.
Applicant Name*
Signature: ^1
The fore oing instrument was a wledged before me thus c r
day of l by -7
who i re _y own r who has produced
As identification
�and
�who did take m oath
NOTARY IIC:I I!( i/ /l. %w;, K YRE IUR 7
Sign: - =—MY"COMMISSION iFRti-7unu! _..—.....__—.._
:.:
I§Int; p, EXPIRES:J'neiftbl,U�erHdtere
''•'gori;°.� 8",ded_M Notary
My Commissionapire
Building Officials Approval:
Re-Oce $60 0_ 0— --
Notary $5 00 _---
Total $
REV 4-10