REOCC-05-23-1096IVA.Lann 01.1V1GS V 111age
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.
RE -OCCUPANCY permit No, C_ D C 0 — e 5 — 23 — /D 1'6
APPLICATION
Contact Name: NINA ROMERO Phone#..305-834-2312
Buyer: Nathaly Karin Moreno Ouniterc seller: Christan & Diana Santiago
Realtor: Shane Graber Company Name: Graber Realty Group LLB
Property Addrem:10618 NE 11 th Court
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 Wormation is accurate.
Applicant
Signature:
na Romero
The foregoing instrument was acknowledged before me this 3
dayof May ,2o_,by Nina Romero
is pemouaily known me or who has producers
As idend atioa, who did lake oath
t' Y LIC:
IVIYAN AMA A
My Commission Expires. -
Building Officials ApF
REV 4-10
=1*4��-NotatyN AMAYA
lic-State of Ffarida
ion # GG 9B4424
ission Expires
04. 2024
Re-Occ $60.00
Notary $5.00
Total $