REOC-04-19-870RE- OCCUPANCY
APPLICATION
Miami Shores Village
Building Department 1 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Bar;
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 (�
Permit No. �qr_- 4 -19 I — CPS-! C)
Contact Name: Juan R. Martinez
Buyer: John Salt and Ana Hernandez
Realtor: John Salt
Property Address: 65 NE 107th ST
City: Miami Shores State:
Phone#: 305 - 761 -1671
Seller: Juan R. Martinez and William P. Bryan
Company Name: The Salt Group
Florida
33161
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: I certify that all the foregoing information is accurate.
Applicant Name: Luthmie Jean
Signature:
The fare Ding i1nstrument was ac jnowledged be re me this Fh
day of t; I , 20 M, by
who is pe sonally known to me or who has produ d
1 V 411.4 f Y YIS uQ AA-fd nti fication and who did take an oath
NO AR P LIC:
Sign:
Print.
My Commission Bx#ires:
Building Officials Approval:
REV 4 -10
Re -Occ $60.00
Notary $5.00
Total $ �5
aRES
MIAMI SHORES VILLAGE
I li ti...t11 Building Department
r , 10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Ito Rvt`
Tel: 305 - 795 -2204 Fax: 305 - 756 -8972
Certificate of Re- Occupancy
Address: 65 NE 107TH ST
City: Miami Shores
State: FL
Zip: 33161
Permit No. REOCC -04 -19 -870
This certificate verifies that the reference property has been inspected by Miami Shores Village and has
been determined to presently comply with schedule of regulations of Miami Shores Land and
Development Code pertaining solely to the requirement that each one - family dwelling is used and
intended to be 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 inspections of the premises in order to determine the condition thereof.
Building Approval.