REOCC-03-20-459°RCS M IAM I SHORES VILLAGE
Building Department
. 10050 N.E. 2nd Ave, Miami Shores, Florida 33138
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Tel: 305-795-2204 Fax: 305-756-8972
Certificate of Re -Occupancy
Address: 41 NE 107TH ST
City: Miami Shores
State: FL
Zip: 33161
Permit No. REOCC-03-20-459
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:
RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer:
Miami Shores Village
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
t4clln
Permit No.
RECEIvy
N1 0 2 20 p
BY:
Frederick Tan Phone#: 305-206-9773
Violeta Perez & Diego Barassi
Realtor: Jack Coden
Property Address.• 41 NE 107th Street
Seller: Frederick Tan & Mark Hyde
Company Name: Keller Williams
City: Miami Shores State: Florida Zip; 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: Frederick Tan
Signature: - 'w L' "
L. .
The foregoing instrument was �owgcd before me this
day of6&.1q. 201P by s� l
who is rgigll known ld me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: __
Print: �~
My Commission Expires:
Building Officials Approval:
:►"� TRACEY BUONAROTA
MY COMMISSION # (3a110227
EXPIRES May 31, 2021
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10