REOCC-08-23-1895 53 NW 107 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: JO ANN C. ALDIVA
Buyer: VASS GROUP LLC and/or assignee
Realtor: GREGORY SALGADO JR.
Property Address: 53 NW 107th STREET
Permit No.oby
Phone#: 786-873-1479
Seller: ESTATE OF MARTHA FISCHBACH
Company Name: GOLDBAY REALTY, INC.
City: Miami Snores State: Florida Zip: 33168
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.
ANN C. ALDIVA
Applicant Narn��!�r,r�
The far oin in from t was acknowledged before me
eethis 2_
day of , 20` , by rn 0—. IWA Va.
who is p rsonally known to me or who has produced
As jdc htificattion and who did take an oath
r
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials Appro
REV 4-10
T�Y ry"•
;��• '•�e::,; HEBERT MARTINEZ
A :q MY COMMISSION N HH 323276
4 EXPIRES: October 18, 202t
• UG :D.:
Re-Occ $60.00
Notary $5.00
Total $