Re-Occupancy Application REOCC-03-23-666vt
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RE -OCCUPANCY
APPLICATION
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
pHTUT
MAR 1 2023 D
By
Permit No. a3 — CQ (e So
7�/a— 973 —`rL,!;
Contact Name: Ivette Elizondo 1 Meland Budwick, P.A. Phone#: 305-358-6363
Buyer: Anna Kuzmik Sampas Seller. Cooper Florida EstatesLLC
Realtor: Jeffrey Fields
Property Address: 9767 NE 13th Ave
Company Name: One Sotheby's International Realty
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'.
Signature:
The foregoing instrument was Kknowledged before me this t9 �
day of tLQLX 1 , 2023 , by 1 l rra (3y-av, t ,
who is erp sonally kDq_Wn to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
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My Commission Expires: A,.( 911 ST- ( It 2. 0 2-3
Building Officials
REV 4-10
. _AW.i;y JANETTE M. GAFCIA
(f • K Notary Politic - State of Florida
y� ' Commission : GG 353452
*','�. AV! My Comm. Expires Aug 11. 2023
Bonded through National Notary Assn.
Re-Oce $60.00
Notary $5.00
Total $