REOCC-07-24-1774Miami Shores Village
RE -OCCUPANCY
APPLICATION
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
Permit No.
Contact Name: Joey Waknin Phone#: 305-395-2378
Buyer: Andre Bordon de Godoy Pinheiro Seller: Rosa Blair and Gordon Blair
Realtor: Ronald Platt Company Name: Keller Willoams Realty St. Pete
Property Address: 79 NW 97th 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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
Signature:
The foregoing Hrument was acknowledged before me this I I {�
day of \t.)1_4_ 20 1�j by 7oG y wAt, NW
who is personally known tome or who has produced '
(L,e.G"s qs identification and who did take an oath
NOTARY PUBLIC:
Sign: W1 �Ly°�+.t�'
Print: u1"'1 add" CI 'eL
My Commission Expires:
Building Officials Approval: tZ14
a� fs 2
FY
;;U., WENDY RODRIGUEZ
f • fir: Notary Public - State of Florin
ih Commission k HH 528689
`-'.?'or F My Comm, Expires May 19, 2028
bonded through National Notary Assn.
Re-Occ $60.00
Notary $5.00
Total $ (oC''C-iO
REV a-10