REOCC-06-24-1602Miami 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.
APPLICATION
CDr
Contact Name: Maji (Maria) Ramos, Listing Agent M Ai i a�% pyi a i t SO Phone#: 305-519-7940
Buyer: Canor Pato and Carla Grisoni Seller' Isabel Gomez Bassols
Realtor: Maji (Maria) Ramos Company Name: ColdweB Banker Realty
Property Address: 137 NE 92 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.
Applicant Name: —Isabel Gomez
Signature:
The foregoing instrLment was acknowledged before me this _
k t day of /8 �20 y — i �ict42eJ 66rxQ
who is personally known to me has produced iuee"s
As identification a ho id take an oath
NOpICRY UBL(¢:
Si
Print:
My Commission Expires: / 9/,7 l
Building Officials Approval:
061
REV 4-10
z �.o �Me1 e65541
O9 o"etlee i�N �e�.' �0�:
Re-Occ $60.00
Notary .9E1�
a
Total $ (P0•