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Miami Shores Village
Building Department
1/24/03)
Certificate of Re- Occupancy
The following residence is issued a Certificate of Re- Occupancy
Address g s /V 9a-
City Miami Shores State Florida Zip
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.
Building Officials Approval:
10050 N.E.2nd Avenue
Miami es, - Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. AOR-0 OS / o/
Date �� �f
P-62;440'&. q• if Q71✓1
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildng Inspection Request w) N
Date q
Type Insp'n
Permit No.
Name
Address
Company
Phone # 3 G. 3 12 3- a c
Inspection Date b7/✓
Approved�i
Correction ❑
Re- Insp'n Fee ❑
6,7(A
i
ave.
(Rev. 10/02/03)
• Miami Shores Village
RE- OCCUPANCY
APPLICATION
Building Department
Loc ID
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
'erinitNo.
Date <5/9/2oc
Contact Name ���O ®-.!-
Buyer Seller Realtor Company Name
Property Address 84 A/6
City
Phone # _gP -303- Z cfs
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 AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name
t‘Art
produce
Signature
The
oing instrument was acknowledged before me this
NOTARY PUBLIC:
P iti tiM O L I�
61aP /
My Commission Expir• s:
Building Officials Approval:
, who is personally known to me or
QP
, 1 1 1 C 1\ ' ' ' 1 �.
identification and who did take an oath.
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Ginn;y it- . Gonell — (�
Commission #DD323870 Total (
Expires: May 26, 2008
Rondrd'a
Atlantic Bonding Co., Inc.
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