Re-Occupancy Application REOCC-04-23-923DigiSign Verified: OC9A7E77-1FIE41E6-BC3F-C9894FBBD935
�91 Miami Shores Village
�e ����'� 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
RE -OCCUPANCY Permit No.
APPLICATION
Contact Name: Mario Pacheco
Buyer:
Jennifer Fuqua
Seller:
Daryl and Mark Gallo
Realtor: Mario Pacheco Company Name:
Property
933 NE 99 St
EXP realty
tek�
A_-CeC-o*1 23 -4V3
305-491.5584
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: ✓tom _V4*40A"
The fore oing instrument was acknowledged before me this ��
day of =� 20 25, by 1144b P c%.-r.
who is personally known to me or who has produced
As identification
N0TAqZ.Y PU IC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
REV 4-10
who did take an oath
NORMAN C. POWELL
NOTARY PUBLIC
ESTATE OF FLORIDA
Co mrn# GG936342
t Expires 1/8/2024
Re-Occ $60.00
Notary $5.00
Total $