REOCC -02-24-409Miami Shores Village
RE -OCCUPANCY
APPLICATION
Contact Name:
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
I.
Permit No. I lww to -
Buyer: hI\l. cs Seller: '3" try-r--Tji)
Realtor: Company Name:
Property Address:ST�9 ) rJC<u�3
City: Miami Shores State: Florida —Zip.�jj�
C"?10��
I hereby certify that I understand that the zoning for this 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.
APPLICANT'S AFFIDAVIT: 1 certify that all the foregoing information is accurate.
Applicant Name: UN—r --1 C-'�C-
Signature:
cC
The foregoing instrument was acknowledged\Ubre me this
day of , 20 4, by ?frki Gib but h
who is personally known tome or who has produced 4 ,
As identification and who did take an oath
NOTARY PU LIC:
PPIE YAO
Sign: KRISTINE KE
�� ,'� Public - state of Florida
Commission N HH 452221
Print: 4�F:'comm. Expires Oct 8, 2027
-Bonded through National Notary Assn.
My Commission Expires:
Building Officials Approval:
�11-31Z-y
REV 4-10
Re-Occ $60.00
Notary $5.00
Tota I $