REOC-3-15-676MAR 2 6 2, 01
f-) - , -5 _7��
Permit No. aw c, I — (� z_
111y SIMON
Contact Name: (t1,tV 2 ,y _]00AeVV% Phone#: 30S7. L+-'� L4
V
Buyer: Donald J. Hayden Seller: Clifford & Alecia Walters
Realtor: Juan Salas
Property Address: 310 NE 99th Street
City: Miami Shores State:
Company Name: EWM lnternation,al
Florida
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:_Ppy"Z!jj# �den
Signature CZ
: I ��
The foregoing �'tumen't was acknowledged before me this
day of March 20 b
1�9 , y
'by N)P"0161 1&1',Q(4,?P`1,
who is personally known to one or who has produced a Florida
Driver's License As identification and who did take an oath
NOTARY pU "L.
Sign:
Print: Jo I na
My Commission Expires:
Building Officials Approval:
REV 4-10
o'
J AWNA 'SOSA
2zigi
Re-Occ $60.00
Notary $,5.00
Total $ 60.0,0_
Building Departmen,t
10050 NE 2 Ave, Miami Shores Fl, 33138
Tel: 305-795-2204- Fax.- 305-756-8972
Permit No, REOC-3-15-676
Certificate of Re-Occupancy
Address- 310 NE 99 Street
City- Miami Shores
State: FL
Zip- 33138-
This certificate verifies that the reference property has been inspected by Miami Shores,
Village and has been determined to presently comply with schedule of regulations of
Miami Shores Land and Development Code pertaining solely to the requirement that each
one-family dwelling is used' and intended to be used for a one-family dwelling purpose
only; however, this certificate does not constitute any representation or warranty as to the
condition of the dwelling or other structures on the premises described herein, or any
aspect of such condition, and interested persons are advised and! encouraged to make
their own inspections of the premises in order to determine the condition thereof.
K
Bu ing Approv
?