Re-Occupancy Application REOCC-03-23-635RE -OCCUPANCY
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. r'\ E6 LIC - 63 Z 3 3 s
APPLICATION
C1oy�¢ P lh�wrs� i3o���S�I--7Co1rt
Contact Name: Nancy Dowson Phone#: (305) 694-2166
Buyer:
Julieta Fracchia Seller: Gayle P Henderson
Realtor: Nancy Dowson Company Name:
Keller Williams Capital Realty
Property Address:. 174 NE 107 ST
City: Miami Shores State: Florida Zip: 33161
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- C-1
Signature:
O:r
The foregoing instrument was acknowledged before me this
day of KAYtA- , 20 Z3, by
who is personally known tome or who has produced F 5 -
cJr � vet L I L As identification and who did take an oath
NOTARY PUBLIC:
Sign: V `--' �o'�err&si,� VIVIBOOeYaO
.. ;oMnAR22200
Print: V l VI,'•e—V% �� �• �T= Expires: Jan.31,2026
y p t (3 l (zo ZG '% aw Notary Public • State of Florida
M Commission Expires: ''n�rr°i `�
Building Officials
Re-Occ $60.00
Notary U98
Total $fdm (0 0 . CO
REV 4-10