REOCC-06-24-1591Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miatni Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No. ILE O CC— 0(0-24-1 S4'
APPLICATION
Contact Native: Mario Pacheco R phone#• 305-342-9908
Buyer: Hector Castro f'FI' Seller: Eric & Ashley Woodling
Realtor; W aY i fl NLG)l1e-Co Company Name:
Property Address: 1060 NE 104th 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 Name: Mario Pacheco
Signature:
The foregoing instrument was aclonowledged before me this
day of�/Je 20o41 � by / /QRi b J10a c-AEco
who is personally known to me or who has produced
As identification did take an oath
NO RY P 7�LIC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
od ze zy
-------------
NORMAN C. POWELL
P Notary Public - State of Fbrlde
'�Ae Commission # HH 459197
`-I ryds My Comm. Expires Jan 8, 2028
-Bonded through National Notary Assn.
Re-Occ $60.00
Notary $5.00
Total $
REV 4-10