REOCC-08-23-1986 465 NE 102 STMiami Shores Village
Building Department
1- 0 050 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: David Pullman
Permit No. 066 - 09 - 23- lqRq
Phone#: 914-906-9208
Buyer: Daniel R Macauley & Ekatherina Tatochenko Seller: Christopher C Herbert & Lisa Herbert
Realtor: David Pullman
Property Address: 465 NE 102nd St
Company Name: One Sothebys International Realty
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 AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Nam cEsa Oerbert
Signature:
The fdtegd g instrument was acknowl
day of August 20 _ by Lisa i
before me this 10th
who is personally known to me or who h2s produced rivers License
As identification and who did take an oath
NOT
Sign: 7
Print: i
My Commission Expires: y 12-1 12D
Building Officials
REV 4-10
'0_1 ti 1 Z
-�,� �' •A Notary Public State of Florida
Natalie Jeri Zagury
y t. o My commission GG 943219
�43 � Expires/2� 24�
Re-Occ $60.00
Notary *-R ft
Total $ Wo. r�—