REOCC-05-23-1143RE -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
Permit No. �' ~� (4-0 ,
Julia Negrevergne Phone#:786-239-3427
Buyer: Annette Malkin and Ryan Malkin
Realtor:
Property Address: 429 N E 99th street
City: Miami S Bores State:
Seller: Julia Negrevergne
Company Name:
Florida
P:
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: Julia
ne
Signature: ITtiU
The foreg ing instrument was acknowledged before me this
day of 20 Z, by 17%t ' 0 It mV!.r,
who is personal known to me or who has produced
As iden fsc I andeho id rake an oath
NOTA Y PUBLIC:
Sign: r:. •..
.: ...... HEBERT MARTINEZ
Print: =•• MY COMMISSION N HH 323276
My Commission Expires: IC) EXrIRES: Ociuber 18, 2026
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total $ (Q 0- aD
REV 4-10