RE-OCCUPANCY1 'MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 \ /
Building IInspection Request J c
Date 9\4 //
Type Insp'n Z
Permit No. AF 1 O 5 o
Name 00 '
Address 34,18 4J 1L q/ sf
Company 111W AI
Phone #
Inspection Date
Correction
Re- Insp'n Fee
a
(Rev. 04/24/03)
Address `
Building Officials Approval:
Miami Shores Village
Building Department
Certificate of Re- Occupancy
Permit No.
Date
The following residence is issued a Certificate of Re- Occupancy
City Miami Shores State Florida Zip 33 se
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
This certificate verifies that the referenced property has been inspected by Miami Shores Village
and has been determined to presently comply with the schedule of regulations of the Miami Shores
Land and Development Code pertaining solely to the requirement that each one - family dwelling is
used and intended to used for a one - family dwelling purpose only; however, this certificate does not
constitute any representation or warranty as to the condition of the dwelling or other structures on
the premises described herein, or any aspect of such condition, and interested persons are advised
and encouraged to make their own inspection of the premises in order to determine the condition
thereof.
FROM : NANCYSTEAM
r
Building Department
(Rev. 10/02/03)
RE- OCCUPANCY
APPLICATION
Date
Contact Name 6'0 Phone # 20S 7,1 — v ( Q
Buyer Seller Realtor Company Name } j.IJei✓ WA 1 .
Property Address ,
a
PrtY
City Miami Shores State _ Fl Zip 33 13
I hereby certify that I understand that the zoning of the 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.
OWNER'S AFFID VIT: I certify that all the foregoing information is accurate.
AcA-if--GO
Applicant Name
Signature
The foregoing instrum t was acknowledged before me this day of , 20
by who is personally known to me or who has
produced
NOTARY PUBLIC:
Building Officials Approval:
FAX NO. : 3057516605 Apr. 05 2005 12:56AM P1 /1
Miami Shores Village
APR o t 225 Permit No. 17 n S- 7Q .
Loc ID
E 9 L - s
10050 N.E.2nd. Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax; (305) 756 -8972
as identification and who did take an oath.
Sign: Re -Occ. $60.00 V
Print: Notary 55.00 //"
My Commission Expires: CCF $0.60 (/
Total
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