REOCC-07-23-1725 1165 NE 105 STMiami 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: Johanna Bassols
Buyer: Sandra Cardona
Realtor: Johanna Bassols
Property Address:1165 NE 105 st
Permit Now-07--?3 472G'
Phone#: 786-587-5689
Seller: Johanna Bassols/ Gregory Shaughnessy
Company Name:
Oceanica real estate
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 AFFIDAVTI': I certify that all the foregoing information is accurate.
Applicant Name: Johanna Bassols
The fooing instrument was acknowI d�cd before me this
day of2Q;�t5by _ ->
who k per onalfy known to me or w$a ha produced,
Q,►�S _ As identification and who did take an oath
NO1
Sign,
Print
My(
Suil,
�rcay GISEL HERNANDE
x�• r g`t Notary ?utrlle - State of Ftorida
Carnmission K GG 9G8971.
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Bor•decl ,hrou l+. Naticnai yotcry "r%
Re-Occ $60.ao
Notary 5.00
Total
REV 4-10