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APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
(if (V( /LI
b.ereby apply for a certificate to re- occupy the single family residence (mown as: (address)
U Z S T , Miami Shores, Florida_
Legal description:
Lot: ‘ ,Block: / ) ,PB&PG: � "c:3
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 Miatni Shores Village, riorida, cerufes only
that the referenced property is being used for single- family purposes and that such Cerriiicate does
not constitute any representation, warranty or certification as to the condition of the dwelling or
other structures on such property.
Applicant:
K
Print Name: C7ec (1
*******:********************* * * * * * * * * * * * * * * * * * * * * *** * * * * * *_*
For the purposes of conducting the inspection required by Section 902 of the Miami Shores
Development and Zoning Code, contact Oft E3m E4- Xe�e..
Contact Name: - )e r / L/* T hone: -c& i 7' .)'',
,,
Buyer_ Seller:_ Realtor. )■Company Name:
966 L !J
•
- Application Fee (S50) Paid: Cash: • Checi: Number
enied: _Date:�0' /�..
CER'Tii+`ICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described
in the application has been inspected for the purposes of re- occupancy pursuant to Sections 901
and 902 of the Miami Shores Land Development and Zoning Code and that such property may be
re- occupied by the applicant for single - family residential purposes.
MIAMI 't' 0 : S VILLAGE, FLORIDA
BY
Date of Certification:
THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY
HAS BEEN INSPECTED BY MLAMI SHORES VILLAGE AND HAS BEEN
DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF
REGULATIONS OF THE MIA II SHORES LAND AND DEVELOPMENT
CODE PERTAINING tG SOLELY TO THE REQUIREMENT THAT EACH
ONE-FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR
A ONE- FAMJLY DWELLING PURPOSE ONLY; HOWEVER, THIS
CER'TIF ICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR
WARR r'TY AS TO ' i iiE CONDITION OF THE DWELLING OR OTHER
STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY
ASPECT OF SUCH CONDITION, AND INTERESTED PARTIES ARE
ADVISED AND ENCOURAGED TO MAID '1 - H.:IR OWN INSPECTION
OF THE PREMISES LN ORDER TO DETERMINE THE CONDITION
THEREOF.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 1 I I
Tax Folio 11 3 1 ' 'OS •O 1 • 60 3
Legal Description Historically Designated: Yes No
Owner/L.earrtiiiinant '113 * 101. St
Owner's Address 1100 V `. Phone
Contracting Co. Ow r/ Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) a UIL 1 1 G ELE TRIC L PLUMBING E CAL ROOFING PAVIN FENCE GN
WORK DESCRIPTION e t k � 41 L R. o It
B R
Square Ft. Estimated Cost (value)
Master Permit #
379 3 3
73 - 3
* Goo 5
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is ac ate and th. t all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the abov named c• • a actor to •o the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT 74 RADON C.C.F.
Mechanical Plumbing
APPROVED:
Zoning Building
o Contractor or Owner Builder Date
Date N
M C SStiai Eg t. NOTARY SEAL
;‘,RA RA M MONTIEL
* COMMISSION NUMBER
• CC401261
-7 (p. COMMISSION EXP.
OF F AUG. 17.1998
Electrical
-r
TOTAL DUE et
Date
Engineering