REOCC-11-23-2743 149 NE 104 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: Jessica Bazan
Buyer: Blanca Lida Buenano Perez
Realtor: Jessica Bazan
Property Address: 149 NE 104 Street
NOV 0 3 2023
Permit No. Kc oce - q3
Phone#: 7862135333
Seller: Hung Duc Pham and Kathleen T. Pham
Company Name: Keller Williams Eagle 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 ]
Signature:
The foregoing instrument was acknowledged before me this J
day of , 20 91, by C
who is personally known to me ar a has produce
R�Ock% G C_ As identification and who did take an oath
NOTARY PM-LIC:
Sign:
Print:
KRISTINE KEPPLE YAO
Notary Public - State of Florida
Commission # HH 452227
MY Comm. Expires Oct 8, 2027
Bonded through National Notary Assn.
My Commission Expires:
Building Officials
Re-Occ $60.00
Notary��
Total $ .
REV 4-10