REOCC-11-23-2903 10561 NE 2 PlMiami Shores Village
Building Department
10050 N,E-1.2nd Avenue, Miami Shores, Florida 33139
TO: (305) 795.2204 Fax: (305) 756.9972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY
APPLICATION
Mario Pacheco
Contact Name:
11myer: SBP group LLC and/or assigns
Realtor: Mario Pacheco
Permit No, f�tGCC- I 1 - 2-3 -- 2903
one#: 305-342-9908
Seller: Donna Joseph as personal representative
Company Name:
Property Address: 10561 NE 2 PL MIAMI SHORES, FL 33138-2004
EXP realty
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. 1 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: Mario Pacheco MY
Signature: k A`tpb U- 0
The foregoing instrument was acknowledged b are me this Aa
dayaf p►�CH r2033,by 44,/V �tG�iGro
who is personally known to me or who has produced
As identification and why did take an ouch
NOTA Y PURL
Sign: / ,�j,
Print: A&,V�f M C �J
My Commission Expires: /l?fao2,X
Building Officials Approval:__
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*AV4 NORMAN C. POWELL
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG936342
Expires 1/8/2024
Re-Oce $60.00
Notary Si£9-
Total $ 6,o. a>
REV 4-10