Re-Occupancy Application REOCC-03-23-687Miami Shores Village
"'7 Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
^7� Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY
APPLICATION
Permit No. 1?E6CC- o3-Z3-607
Contact Name: Nancy Dowson Phone#: (305) 694-2166
Buyer: Pedro L Porras Seller' Douglas M Jacobs
Realtor: Nancy Dowson Company Name: Keller Williams Capital Realty
Property Address:
220 NE 105 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.
Signature:
The foregoing instrument was acknowledged before me this le
day of R4W,20-Y by ki&, 46- /V �11CLQS
who is personally known to me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: T
Print:-VJI'1P1G. c'�25 �G.a�s�c
My Commission Expires:
Building Officials
.v "'•••., DONNA SELDES HOMANSI(Y
Notary Public - State of Florida
€ ®' Commission If HH 308738
'an;? My Comm. Expires Oct 9, 2026
Bonded through National Notary Assn.
Re-Occ $60.00
Notary $5.00
Total $ 65.00