REOCC-08-23-2100 272 NW 111 TerrMiami 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: Ryan Sullivan
Buyer: Jerry Zhang
Realtor: Ryan Sullivan
Property Address: 272 NW 111th Ter
City: Miami Shores
Permit No.
&cc.- 6- J3-))a,
Phone#• 305.450.3786
Seller: Brandon Gaia
Company Name: Keller Williams Miami
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.
Applicant Name: Ryan SU
Signature:• _ Q` ' U
r�? `
The foregoing instrument was acknowledged before me this
day of , 2027 , by ky'tJ/r>��,
who is personally known tome or who has produced dL D t TYL
As identification and �U did take an oath
NOTARY PUBLI�
Sign: i'
Print:
My Commission Expires:
Building Officials Appri
REV 4-10
ARLENIS SILVERA
MY COMMISSION # GG 950477
- :.. ; XPIRES: March 6, 2024
Bonded Thru Notary Public Underwriters
�•.:1QR?:b�.---FAO -mil-p
Re-Occ $60.00
Notary $5.00
Total $