REOCC-01-20-180RECEIVED
RE -OCCUPANCY
APPLICATION
Contact Name:
Miami Shores Village J N 2 4 2020
Building Department BY
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.
Reinaldo Delgado
Buyers Gwendolyn Villoch
Realtor: Jodi Pollack
Property Address: 269 N W 111 th met �(
Phone#: (305)401-3900
Seller: Blessed Management Group LLC.
Company Name: Platinum Realty & Investments
City: Miami Shores State: Fl
Zip: 33168
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. 1 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
Signature:
The foregoing instrument was acknowledged before me 1111scz "
day of y 20 PC, by �.� .v�o�+a... �. � �1QG -
who ispersonally kJnown to me or who has produced
As identification and who did take an oath
NOTARY 1. LIC:
Sign:
rr
Print: c w -0- R
My Commission Expires: J mI'nca3
Building Officials Approval:_____
Notary Public hate or Florida
Clarissa De La Hox
Exp res 0811 V2023 385964
Re-Occ $60.00
Notary $5.00
Total $ (DO - Gb
REV 4-10
MIAMI SHORES VILLAGE
Building Department
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Permit No. REOCC-01-20-180
Certificate of Re -Occupancy
Address: 269 NW 111TH TER
City: Miami Shores
State: FL
Zip: 33168
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.
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