REOCC-05-23-1088Miami 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
RE -OCCUPANCY
APPLICATION
Contact Name: Michael Antkowiak
Buyer:
Realtor: Sam Chute
Property Address:9338 NW 2nd Avenue
Permit Noftcc"Czr�3_ i0,5s
phone#: 832 483 5244
Seller: Michael Antkowiak
Company Name: Redfin
City: Miami Shores State: Florida Zip: 33150
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 P
Signature:
The lorc:goin= instruine:lt�was ac�k>)>wledged before me tthis V--
day of , 20Z3 . by 1'Z�C���Ql I - `.0t" 3
who is a14 known to me or who has produced
As i ent• icati on and who did take an oath
NOTARY PUBLIC:
Sign: HEBERTMARTINEZ
Print-.
_•i MY COMMISSION # HH 323276
Of iQh� EXPIRES: October 18, 2026
My Commission Expires:
Building Officials APp
Re-Occ $60.00
Notary $5.{1{�
Total $
REV 4-10