REOCC-06-24-1613Miami 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: Nancy Dowson
�.J., L 0 2024
Permit No. Fl5btC - 6. -,)q- / i L�
Buyer: Premium Ventures LLC Seller: Sofia Barreto Crandall & Will Crandall
(305) 694-2166
Realtor: Nancy Dowson Company Name' Keller Williams Capital Realty
Property Address' 62 NW 109 ST
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.
N
Signature:
The foregoing instrument was acknowledged before me this`k I 0� V
day of" 20l,by 5S1A gftaef — (kjfLPd*4(
who is personally known to me or o has produ d
'f->tfC &i bi64 U C_ As identification and who did take an oath
PUBLIC:
Sign:
i
Print: 'L a
My Commission Expires:
Building Officials
KRISTINE KEPPLE YAO
Not,,V NNE c - State of Florida
Commission p HH 452227
My Comm. Expires Oct 8, 2027
-d through National Notary Assn.
d A /21
Re-Occ $60.00
Notary $5-.06—
Total
REV 4-10