REOCC-06-24-1680RE -OCCUPANCY
APPLICATION
Contact Name: Crystal Acosta
Buyer: Martha Nassalska
Realtor: John Salt
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fan: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762A949
Permit No. 2Ean-c- 0(.0 -Zy - I& '
Dora Bennett Waller
Name:
(786)977-9996
Keller Williams Eagle Realty
Property Address: 6 NW 106th St
City: Miami Shores State: Florida Zip: 33150
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.
APPUCANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
The foregoing instrument was acknowledged before me this ROf1
dayof—;&g--2l&by _009A i' vt,7 1t H)A4ke2
who is personally known tome or who has Produced neiw 5
JL l'l ig As identification and who did take an oath
NOTARY PUBUC- /�
Sign: � '/ v
Print: L , j_4(
My Commission Expires:
Building Officials Approv
U7 0� Zy
REV 440
j. BELLE L. JACKSON
l NotM Public • State of Flonea
{'A� ? CommhtlonI XH )aCrstI
>r/ m, Cieux. Eatir" Jul 10. 10:
Banda* OMSK Nattcnd NCUry Attu.
EN-PnRED
JUN 12024
Re-Occ S6o.00
Notary egg.
Total $ (. U . 00
BY: C5S&