Re-Occupancy Application REOCC-07-25-1655Miami 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) 762A949
RE -OCCUPANCY
APPLICATION
Contact Name: Crystel Acosta
Ana Carolina de Toledo Moreira & Tiago Galvao Nunes Portela
Buyer: Seller:
FJ
CEw!l0.-UL 2 1 2025
BY
Permit No. 4rtc- V 1� - I `r
Phone#: 786-977-9996
John Patrick Salt and Ana Hernandez
Realtor: John Salt Company Name: Keller Williams Eagle Realty
Property Address: 65 NE 107 Street
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: John Salt
Signature:
The foregoing instrument was acknowledged before me this 17th
day of July 20 25. by John Patrick Sall
who i persnown o e or who has produced
As identification and who did take an oath
NOTARY PUBLI /
Sign: /( {
Print:
My Commission Expires:
Building Officials Approval:
REV 4-10
�jj°'� KELLE L. JACKSON
(�� •` Notary Fubllc - state of Flodda
.'!i�vs��� C°mmissior� 4 HN 3B669I
- °�^ �' My Comm. EKpves Jul I0, 20II
aonEeC through National xotaryAssn.
Re-Occ $60.00
Notary $5.00
Total $ �5 .'