REOCC-08-23-2063 160 NW 92 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 Permit No. 2OPCC- O�— )3 J-o�3
APPLICATION
Contact Name: Daniel Adsit Phone#: 305-905-9327
Buyer: Fabricio Bohrer Seller: Eagle REI I Holdings
Realtor: Daniel Adsit Company Name: Robert Bourne Real Estate, LLC
Property Address:160 NW 92nd Street
City: Miami Shores 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 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: Daniel Adsit
Signature•
The for oing instrument was acknowledged before met is
day f 20Z by hp -F
w is r, nally known to m who has produced
As identification and who did take an oath
NOTAR P LIC:
Sign:
Prin : d1.:.. YDIAZ
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My Commission E fires. EXP RES: June 17, 2025
Bon od Thru Notary Pubic Undemicets
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10