REOCC-09-23-2384 173 NW 107 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: ROBERTO ESPINO
Buyer: KATRIK LLC
Realtor: NELSON GONZALEZ
Property Address: 173 NW 107 STREET
Permit No. e6'(C_ 09-0- �13Y'
Phone#• 305-788-0082
Seller: R & M INVESTMENTS PROPERTY GROUP LLC
Company Name: FORESIGHT REALTY GROUP CORP
City: Miami Shores State: Florida
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
STMENTS PROPERTY GROUP LLC
Signature: ' cv�:�
The foregoing instrument was ackno qd�gebefore me this
day of 20 3by —
who is personal own to me or who has produced
As identi ion and who did take an oath
NOTARY PUBIS
Sign:
Print:
My Commission Expires: ?° ••"'•�� LEIDAC. PEAE2
* * Comn*sIgn # NN 261230
w"�' OF Expires June 06,
Building Officials Approval:
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10