REOCC-07-24-1831DocuSign Envelope ID: B5EF74CA-C469-4F02-91
Miami 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
111 : E91Z6Id11l_1014CA
APPLICATION
Contact Name: Brianne Elizabeth Sander
Daniel Cano Bibas and Alejandra Gonzalez Valle
Buyer: Seller:
Realtor: Daniels Zohlman #3472787
Property Address: 166 NW 98th st
Permit No. r ` EOC-C -07- Z!-) - IS % I
732-266-6349
Phone#:
Brianne Elizabeth sander
Name: Douglas Elliman
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.
Brianne Elizabeth sander
Applicant Name:
Signature:
State of Nevada, County of Clark12th
The foregoing instrument was acknowledged before me this
day of duly 2024 by Brianne Elizabeth Sander
who is personally known to me or who has produced
Passport As identification and who did take an oath
LaII_ll'l1�1 ] 1l L�F
Sign: 40 A,7r2`
Print: Mark A Braddy
My Commission Expires: 01/07/2026
Mark A Braddy
�,•_�,':'�
NOTARY PUBLIC
STATE OF NEVADA
Appt. No. 22-6997-01
••�
Expires January 7,2026
Notarized remotqQ usin dio-video communication technology via Proof.
Building Officials Approval:
EN'rER l
REV 4-10 JUL 17 2024
Re-Occ $60.00
Notary $5.00
Total
BY: �