Re-Occupancy Application REOCC-06-22-1474RE -OCCUPANCY
APPLICATION
Contact Name:
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. &C&-L/gc - & ` Z z - /L/ 7q
Beniamin Rogers Phone#:7863908835
Buyer: Taniun Development LLC Seller: Beniamin & Kristina Rogers
Realtor: Georqee Kluck Company Name: Keller Williams
Property Address:10618 NE 11 th Ave
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 Nane Be n i a m i n Rog a rs
Signature:
The foregoing instrument was acknowledged before me this 9
day of k Kz , 20 ZZ , by i3t4� y a
who is personally known to me or who has produced /--'
EX�y-6rs L.•L- As identification and who did take an oath
NOTARY PUBLIC:
Sign: � )
v
Print:
--o
My Commission Expires: ;1 13 i I a0 2-6
Building Officials Approval:
,, •. , � ,
Vivienne Yao
•e`'�►':
Comm.:HH 222410
• '
Expires: Jan. 31, 2026
''�%►°„
Notary Public - State of Florida
Re-Occ $60.00
Notary $
Total $ Co G • Go
REV 4-10