REOCC-10-24-2754Miami Shores Village
RE -OCCUPANCY
APPLICATION
Contact Name:
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
ftowAclasw Ejwaved WI (I1 4ms
Cel" bno Pedro Castellon, Marisa Castellon, Gabdela Prendes,
Buyer: Leon Rodrigo Castellon Seller:
Permit No.
Cc -it-2y -27S-1
—) eiv,SLI-lt 2-Cr 32
Edward B Williams and Peter A Ramirez
Realtor: John salt Company Name.•
Property
41 NE 109 St
Keller Williams Eagle Realty
City: Miami Shores State: Florida Zip: 33161
I hereby certify that I understand that the zoning for this property is for single-family residential use
is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-0
that may be issued by Miami Shores Village certifies only that the referenced property is being used
family purposes and that such certificate does not constitute any representation, warranty or certifi
the condition of the dwelling or other structures on the property.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate. LL
Applicant N9�1�� 23_ZJ.CL14. CA .k4 S A-)--)-
Signature:
The foregoing instrument was acknowled#d before me this 2'
day of i�&b•U%by C—ciu�avd W llicrms +
Pei e✓ 12ct rnt✓e z
who is personally known tome or who has produmd F L 0..✓c ✓s
L- rc-•t �' S -C As identification and who did take an oath
NOTARY PUBLIC:
Sign: LLB
Print: t,t)_L l /Q J a-o d v4u.e 2
My Commission Expires:
Building Officials Approval: J
DY RODRIGUEZ
Em
blit •State of Floridassion C HH 528684
19, 2028h
Expires May
National Notary Assn.
Re-Occ
Notary
Total
I that it
pancy
single
on as to
REV 4-10