REOCC-07-24-1761Miami Shores Village
RE -OCCUPANCY
APPLICATION
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.9972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. M-4-67- 2 tq- 17/o (
Contact Name: David F. DePaulis Phone#: 650.808.5155
Buyer: Natalia D. Purisaca / Roger A. Uribe Seller:
Realtor: Leslie Vasquez
Property Address: 41 NW 107th Street
David F. DePaulis
Name: KW Capital / Keller Williams
City: Miami Shores State: Florida zip: 33168
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: David F. DePaulis
Signature: /L_Ll� , k- _24e/
The foregoing instrument was acknowledged before me this 9
dayof,JUVU •202,by _h�czv`�k
who is personally known to me or who has produced r
�r `u tJ3 As identification and who did take an oath
NOTARY PUBLIC:
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My Commission Expires: l � _ €
Building Officials Approval:
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Vivienne Yao
Comm.:HH 222410
Expires: Jan.31, 2026
Notary Public • State of Florida
Re-Occ $60.00
Notary
Total $y CC>
REV4-10 -JULU 9 ZOA
BY: