RF-04-19-828 OWNER AFFIDAVITMiami shores Village
Building Department
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ei f 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795,2204
Fax: (305) 756.8972
OWNERS'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR EXISTING SITE -
BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES
PERSUANT TO SECTION 553,844 F.S.
To Miami Shores Village Building Department Date:
10050 NE 2nd Ave
Miami Shores, FI 33138
Re: Owner's Name: AVV�Z M reams r
Property Address: Ne I e) (N%&t A S�Lpre
Roofing Permit Number: ,AA D� I e 6 r o r 33 % U 1
Dear Building Official:
Icertify that I am not required to retrofit the roof to wall connections of my
building because:
)(The just valuation for the structure for purpose of ad valorem taxation is less than $300,000.00, Please attach proof of ad
valorem taxation.
❑ The building was constructed in compliance with the provisions of the Florida Building Code (FBC) or with the provisions
of 1994 edition of the South Florida Building Code (1994 SFBC)
Signature
State of Florida
County of Dade
Print Name • • •
• •
• Y Y •
• Y Y Y
The undersigned, being the first duly sworn, deposes and says that he/she is 1 � 1
Sworn to and subscribed before me thin �_kxday of A�
Notary Public, Sate of Florida at Large
When the Just valuation of the structure for pL
SFBC. Then you must provide a building appl
owner for the abOvd property mentioneU, • e w
ZoNR ....
ALBERT SEARA
Notary Public • State of Florida
Commission p GG 304563
My Comm. Expires Feb 24, 2023
Bonded through National Notary Assn.
0,000,00, and the building was not constructed with FBC nor a 1994
inection Hurricane Mitigation
Revised on 5/21/2009