Re-Occupancy Application REOCC-11-22-2974y... aw.4' y-�e �e.�.�,-.,�,+tirt,,,:.••;.�»L�.e�.r�i�.s�-���s-:.o�
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_prv Miami Shores Village
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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
APPLICATION
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Permit No. KL- 0(_C- 1I - ZZ -Zg7q
Contact Name: Donald Wilson Phone#:305-335-5722
Buyer: Red Cedar Development LLC Seller: The Estate of Donald Adolph Baumann Jr.
Realtor: Donald Wilson Company Name: Willis Wilson and Associates
Property Address•30 NW 107 Street
City: Miami Shores State: Florida Zip: 33168
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 .Deanna Pioma n Personal
Signature: zd-
The fore1g'o`ing' indent was acknowledged before me this 1H 7
day of , 20 2 L by f }4G vt h-ti ?0,
who is personally known to me or who has produced L 1DL
QLX6 ib3q*" D As identification and who did take an oath
NOTARY U$ I
Sign:
Print: L ✓r
My Commission Expires:
V,� 6�Z-62s
B ding Officials Approval:
REV 4-10
of the Estate
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.*,1 SAVANNA R CHAVEr WAKING
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• Notary Public. State of Florida
t?� 1 Commission M HH 114650
My Comm. Expires Apr 6, 11125
Re-Occ $60.00
Notary 6
Total $ & Q • oo