REOC-10-1100v. 10/02/03)
RE-OCCUPANCY
APPLICATIQN
ea/ 7/1 b
Date
Buyer • 1(
��cllie.. w
Miami Shores Village
Building Department
Seller Realtor
Property Address /50 1\1 00 -
City Miami Shores
State
F1
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 ofRe-
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 . rq,ik S.J ers1e; T lleq / /
Signature
produced
Sign:
Print:
My Comn ission Expires:
NOTARY PUBLIC:
Building Officials Approval:
JUN zOlil
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 - 8972 Permit No. RIC . QC ` — l k : D
Lac ID
Company Name
cYe
Zip 33/SO
The foregoing instrument was acknowledged before me this /S day of Jug e , 20 /
by r'a . /( , who i personally known me or who has
as identification and who did take an oath.
Re -Occ. $60.00
Notaiy
C C 60
Total, ( c c
■
Project: <NONE>
Owner: LAURLE ALLEN
Phone:
Job Address: 150 100 Terrace
Miami Shores, FL 33138-
Parcel: 1131010230290
Block: Lot:
Scheduled Ins • #
PLEASE CALL
CALLIE MINER
801 - 358 -5565
Inspection History
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Ins . ection T • e
Ins • ection Status
APPROVED
Ins • ector Date Com • Ieted
Norman Bruhn 6/21/2010
06/18/2010 INSP- 146318 Re Occupancy
Thursday, July 22, 2010 Page 1 of 1