Re-Occupancy Application REOCC-04-23-945RE -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
Permit No.QEDZ -04
Contact Name: NINA ROMERO Phone#: 305-834-2312
Buyer: MAYDAN TRUST sever: OLIVINE GROUP HOMES LLC
Realtor: Shane Graber Company Name: Graber Realty Group LL,
Property Address:123 NE 99th Street
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 14
day of April 2o_,by Nina Romero
who is personally known to me or who has produced
As identification and who d' take an oath
NOT
Sig
Print: BRYAN AMAYA
My Commission Expires: J_ T— Z� 2-
Building Officials
Re-Occ $60.00
Notary $5.00
Total$ V)-Ce
REV 4-10