REOCC-05-23-1210RE -OCCUPANCY
APPLICATION
Contact Name:
Buyer.
Miami Shores Village
Bug p 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
Permit No. RC EO (/_Q - d S- 2-3 - jZ 10
Sophia Howard
Beatriz Preter
Realtor: Sophia Howard
Property Address.
19 NW 99th Street
Phone#: 305-968-2445
Seller: Brandon Floch, Stephanie Picon
Company Name:
Coldwell Banker Realty-M.B.
City: Miami Shores State: Florida Zip:
33138
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: Sophia
Signature:
The foregoing instrument was acknowle ged before me this 2-
day of 20 23 , by �9 LA, wow'Z'�
who is personally known to me or who has produced �
C)(_` Vy-� L, c- As identification and who did take an oath
NOTARY PUBLIC:
Sign:
Print: Vt 1 l- n r-, a v
My Commission Expires:
Building Officials Approval: vb •�
VivienneYao
G��m.:l�H2x24i0
�xpiras'. J3�r.3t4026
�loiary p��lle • 5iate of Flaslda
Re-Occ $60.00
Notary
Total $ 6 o • 00
REV 4-10