Re-Occupancy Application REOCC-04-23-862:r
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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
RE -OCCUPANCY Permit No.ftcc-04-2-3 -& 2-.
APPLICATION
Contact Name: BRANDON MARTIN Phone#: 786-444-4290
Buyer: MARTIN B. NETSKY Seller: TAMMY M. AUSTIN
Realtor: BRANDON MARTIN Company Name' GRANT & ASSOCIATES REAL ESTATE, INC'
Property Address: 250 NW 104TH STREET
City: Miami Shores State: Florida Zip: 33138
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: BRAND ON A TIN
Signature:
The fore
ff-ooi g� instrument was acnow,ledged before me this
day of 11�" 1L , 20 n
, by Vo&z 13 11
who is personally known to me or who has produced
jAAsi en[' cation and who did take an oath
NOTARY PUBLI-
Sign:
Print viz
My Commission Expires:
Building Officials Approval:
M
HEYERTMARTINEZ
•_ MYCOMMISSION#HH323276
';. EXPIRES: October 16, 2026
Re-Occ $60.00
Notary $5.00
Total$ �Pg-�
REV 4-10