REOCC-09-23-2333 126 NW 100 Terrivi-larni nores v iliage
Building Department
0050 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. er :�oeZ - Oq- 23
APPLICATION
Contact Name: -Nina Romero Phone#. 305.834.2312
Byer: Jeffrey Goudie & Mikaela Diaz Seller: nay "v cW
Realtor: Shane Graben __ Company Name: Graber Realty Group
Property Address: 126 NW 100 TERRACE
City: - Miami Shores State: Florida ---Zip:
I hereby certify that I understand that the zoning for this property is for single-fairuly 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: Nina Romero
Signature:
The foregoing instrument was acknowledge
d before me this
day of Sept 20-0 by Nina Romero
�o is personally known to mesor who has produced ---
As identification and_wh�ffl AaiyAn oath
BFYAN AMA)(A
lic tj 0�,
NOTARY P e f de
ub
11�11 Not TY
Notary ftbllc-StOte 0' Flo"
Commission GG 984424
E
Sign: C
S
My Commission Expires
M 0
May 04, 2021
Print: BRYAN AWAYA
My Commission Expires:
Building Officials
REV 4-10
7 �
Re-Occ $60.00
Notary $5.00
Total $