REOCC 05-23-1114RE -OCCUPANCY
APPLICATION
Contact Name: Alicia Diaz
Miami Shores Village �,DIVED
Building Department MAY U 5 2 23
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 By'
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit NO.
Buyer: Bibin Mannattuparampil & Teena John
Realtor: Jack Coden
Property Address: 1005 NE ST CC 5
305-796-7129
Seller: Janice B Spahn
Company Name: Keller Williams Eagle Realty
City: Miami Shores State: Florida Zip:
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 AFF A VIT: I certify that all the foregoing informatio
Applicant Name: 0, Y a t 1—S
Signature:
The foregoing instrument was acknowledged before me this
day of r�'11�` , 201.DD, by 1 "� [� l /`�- we� lC�
who is personally known to me or who has produced r.A,_ i;)r�%V''"
As identification and who id take an oath
NOTARY PUBLI
Sign:
Print: IL'JERA
MY COMMISSION # GG 950477
My Commission Expires: �: g EXPIRES: March 6, 2024
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total
REV 4-10