RF-05-21-1126 INSPECTION AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # r Z o P-C-
DATE: k ( (1' i
INSPECTION AFFIDAVIT
I 't� C [-� licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: CLCL
On or about" � 2- -i , 1 did personally inspect the roof deck nailing
(Date ti e)
work at
(Complete Job Site Address)
Based upon that xamina 'on I h ve determined the installation was done according to the
Hurricane Miti tion eet ofit Ma uaI (Based on 553.844 F.S)
Signature
State of Florida, Miami Dade County:
The undersigned, being the first duly sworn, deposes wind says that he/she is the contractor for
the above property mentioned.
Sworn to and subscribed before me this
Notary Public, State of Florida at Large
day of
Scg%--�
MARIA R. MEDINA
Notary Public • state of Florida
��• Commission P HH 013383
"'�eFfs my Comm. Expires Jun 22, 2024
Bonded through National Notary Assn.
For Forms and Applications click here:
http://bidg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01142021 inspection Affidavit Page 1 of 1