Re-Occupancy Application REOCC-03-23-763�zek 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
APPLICATION
Contact Name: Jack Schneider
Buyer: Kenneth Kotalik
Permit No. P64 tC -03 - Z3- -763
305-934-1911
Seller: Jack $ Cynthia Schneider
Realtor: Georgee Kluck Company Name: Team Georgee
Property Address:444 NE 100th St
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: Jack Schneider
Signature: G
The foregoing] tstrument was acknowledged before me this 2-3
day ofA&L-Gti,20z3 by-,)[;r1C St tlnefc4t�
who is personally known to me or who has produced El-
i vtrr 1r �L_ As identification and who did take an oath
NOTARY PUBLIC:
Sign: (i �_— L ` / t7
Print: � 1 ✓ i � h n� y 6!-o
My Commission Expires: 1 13 ' 1 ZD Z Co
Building Officials
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Expires: Jan. 31, 2026
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Notary Public - State of Florida
Re-Occ $60.00
Notary $51rW
Total $ Co O • cxo
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