REOCC-08-23-2005 173 NW 106 StRE -OCCUPANCY
APPLICATION
Miami 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
�It oee-
Permit No..
Contact Name: Mario Rodriguez (305 ) :305- q 3 _70 Phone#:786-213-5333
Buyer: Manuel A. Zerquis Molina
"Realtor: Jessica Bazan 786 213 5333
Property Address.173 nw 106 Street
City: Miami Shores
Seller: Mario Rodriguez
Company Name: Keller Williams Eagle Realty
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 Villaga„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 N
Signature: _
The foregoing instrument was acknowledged before me this y
day of 64L' I , 20 23 , by ;"tO to ' �Cr'1 ° ' �' c-_X
who is personally known to me or who has r n d F t'
L«- As identification and who did take an oath
NOTARY PUBLIC:
Sign: L
Print:
My Commission Expires:
r- • . Building Officials
REV 4-10
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Comm.: SH 222410
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Expires: San. 31, 2026
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Notary
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Re-Occ $60.00
Notary
Total $