Re-Occupancy Application REOCC-03-23-816�4p
RE -OCCUPANCY
APPLICATION
Miami Shores Village
Building Department
10050 NTi21d Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER (305) 762A949
Permit No. W C(SC-g; o t y
Contact Name: Crystel Acosta phone#•786-977-9996
Buyer. Madeline Turner & Anthony Taiuro We.: Laureen Clarke & Richard Kruder
Realtor. John Salt Company Name: Keller Williams Realty
Property Address: 126 NW 109 St
City: Miami Shores State: Florida Zip: 33166
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 AFFMA : I certify that 0 the foregoing information is accurate.r ny JANET FONSiCA
Lau ad and Richard Kruder ,E ; : Notary 7ublic - State or Florida
Applicant Name: •;',:` Commission x HH 212733
My Comm. Expires Feb 25, 2026
Signature:
The fore g en�L,p(�as ac wledged i ��2 day of 2(V'— by K.'�" 4
who is personally imown to me or who has produced jGDL• C�)) 4�po1 ScY I rO�i �7c� l v`
As identification and who did take an oath K ' ' /nq•� 05' q� J
NOTARY
Print: V-\C}-)sL QJ.iI TC Vibt1,`l� ii'P-Fh�P•. GLA-�•�S
My Commission Expiras:
Building Officials
Notary $5.00
Total $
REV 410