135 NE 98 St (12)(Rev. 10/02/03)
•
RE- OCCUPANCY
APPLICATION
Date C g f /. 7/3 ,5
Contact Name t vl t tat /Ng SA5ff4 I Q N0
Buyer Seller
Property Address /35' N F 9g '`7';
City Miami Shores
S ignatu
Miami Shores Village
Building Department
State
Realtor Company Name
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 N�•r►Se Gv/ Lh t ,RAVAJA 5,22,e/ix 9RAN -1)T
aelzATA-4
The foregoing instrument was acknowledged before me this 0 5 day of {R off , 20 05
by , who is personally known to me or who has
produced as identification and who did take an oath.
OTARY PUBLIC:
.�� eve FU,.. Mabel / s
4... Con <sion
' 2.3194
Sign: i _ ` : Expires: its 3,2
Thn
Print:
My Commiss n Expires:
Building Officials Approval:
Loc ID
Atlantic frig '•� [!tk
10050 N.E.2nd Avenue
Miami Shores. Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. M — 1
Phone #(36.0‘7V-SW
Fl Zip 3 3/3g
Re -Occ. $60.00
Notary $5.00
CCF $0.60
65.,
Total
MIA S ORES VILLAGE LACE /
BUILDING DEPARTMENT
30 5- 795 -2204
B Inspection Request
Date 3 45
Type Insp'n -.?e' U )1G
Permit No.
Name i vi61. stie,4 h o r
Address S R rsi
Company 14 1(
Phone # 671-R1/
Inspection Date $ ( 10
Approved
Correction
Re- Insp'n Fee