821 NE 99 ST INSPECTION AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
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Permit # �(� DATE:
INSPECTION AFFIDAVIT
O.-K,
t � I .i , licensed as a(n) Cor�nhiraictdr / Engineer / Architect,
(Print name and circle License Type)
i
License #: r ►firs
On or about "� hi i ��A a, I did personally inspect the roof deck nailing
(Date & time
work at
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurrican,e,Mitigation Retyafit Manual (Based on 553.844 F.S)
�gnature
State of Florida, Miami Dade County:
The undersigned, being the first duly sworn, deposes and says that he/she is the contractor for
the above property mentioned.
Sworn to and subscribed before me this
day of
Notary Public, State of Florida at Lar
CATHERINEA. DUFFIN
W COMMISSION # HH 099522
EXPIRES: May 14, 2025
rar t yea 130ndld ThrU NoL y Public Ufld wrftm
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit