REOCC-09-24-2409RE -OCCUPANCY
APPLICATION
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
Permit No. 12 f_OCC—C4'—zq—L'f0
Contact Name: Nancy Dowson Phone#: (305) 694-2166
Buyer: Alfredo Valdesir Seller' Leslie Alan Denning & Christian GUtlerrez
Realtor: Nancy Dawson Company Name: Keller Williams Capital Realty
Property Address: 77 NW 106 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 NaM l ,h1 j 5'h tt v2 61A-y W feji
Signature
The foregoing instrument was acknowledged be a me this 1-7
day of 0�jj,by Ch✓kSl1210 Gs.JC4vr2z
who is personally known tome or who has produced Ft p 1✓a✓5
l_ I. L-e_v u As identification and who did take an oath
NOTARY PUBLIC:
Sign
Print: Got,/,& aZJ `' f u-e- 2
My Commission Expires S( (q zki
Building Officials Approval. y
••.,. WENDY RODRIGUEZ
•': Notary Public • State of Florida
'I Commission 8 HH 528689
.vor rh?. My Comm. Expires May 19, 2028
Bonded through National Notary Assn.
Re-Occ $60.00
Notary $5.00
Total $ 65.00