REOCC-06-24-1398DocuSign Envelope ID: E13A8AF0-32F2ADCD-97CA-5C676B397CA4
Miami Shores Village
RE -OCCUPANCY
APPLICATION
Wendy Gulla
Contact Name:
David Gulla
Buyer:
Realtor: Travis Gibb
Property
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
1269 NE 98th St.
Seller:
,'ui 0 3 2024
Permit No. Q CC l �`i et
Aristidi5 Nanos
ny Name:
9786602289
Keller Williams Eagle Realty
33138
City: Miami Shores State: Florida Zip:
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.
David Gulla
Applicant
Signature: t
The foregoing instrument was acJI�0.JQwledged beforgN��� is 3
day of Tune 2024by VI/GfU�GI` G
who is personally known tome or who has produced Drivers
License Aa idantification and who did take an oath
Sign:.
Print:
My Commission Expires:
Comm #HH0W80
Expires: Nov.17, 2024
Bonded Thor Aaron Notary
Building Officials Approval: -"
1
by:
Re-Occ $60.00
Notary $5.00
Total
RI:V 4-10