RF-05-22-1319 INSP AFFIDAVITMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
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Permit # 4 1 —05`2 i 7:)) C) DATE: 002 l /2 2--
INSPECTION AFFIDAVIT
I licensed as a(nContractor'1 Engineer / Architect,
(Print name and circle License Type)
License #: 6
On or about CXo /21 /22— q 'CC a44 I did personally inspect the roof deck nailing
(Date & time)
work at O.5 NE q(C)HI �+ M(Gm SK_bfe1\ F1 3� t �
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S)
� � 1
Signature
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
M
day of Ju_,ne_ . a-va a
EBONY K LEWIS
Notary Public, State of Florida at Large ;� _ ;Notary Public -State I Florida
�,��?�` My Commission Expires
'�1,5" October 27. 2025
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1