REOCC-06-22-1594 (2)RE -OCCUPANCY
APPLICATION
Contact Name:
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
Seymour Kantor
Buyer: Virginia Gil, Michael S Ross, Jared I Ross
Realtor: Maria Pilar Revoredo
Property Address: 116 NE 97th Street
Permit No. G ^O 1.+.
phone#: 305-922-1385
Seller: Watersedge Shores, LLC
Company Name: Robert Slack LLC
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: eymo r Ka ar for Watersedge Shores, LLC
Signature:
The foregoing instra ent wa acknowledged before me this % Z
day of 20 ?3 , by ,'-, �q YY)ou y'
who is personally known to me or who has produced P-
t-' GAs identification and who did take an oath
NOTARY PUBLIC:
Sign: _ r� �rI
Print:
My Commission Expires: 1 l 3 ` I Zm 2-6
Building Officials A pprov:ai:
■"""''+r vivienneYao
r Y pu4`n comm.:H1422200
Expires Jan.31, 2026
°P ; ■r■``� Natary Public • S1ale of Florida
Re-Occ $60.00
Notary $5.00
Total $ 65.00
REV 4-10