RF-09-22-2243 Owner Affidavit 77 NW 99 StTo:
Re
NOREs Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
wEt 305-795-2204 www.msvfl.qov
1. idR,IDA OWNERS'S AFFIDAVIT OF EXEMPTION
ROOF TO WALL CONNECTION HURRICANE MITIGATION RETROFIT FOR
EXISTING SITE -BUILT SINGLE FAMILY RESIDENTIAL STRUCTURES PERSUANT TO SECTION
SS3.844 F.S.
Miami Shores Village Building Department
10050 NE 2d Ave
Miami Shores, FI 33138
Owner's Name: TD6?e—
Property Address: 14
Roofing Permit Number:
Dear Building Official:
L() a! 9 4A
C-A
Date: /D M
r F -Oc-'f- 22 - ZZ`3
I () c W certify 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 ith the provisions of 1994 edition of the South Florida Building Code (1994 SFBC)
Signatu�e Print Name
State of Florida, Miami Dade County
The undersigned, being the first duly sworn, deposes and says that he/she is the owner for the
above property mentioned. Sworn to and subscribed before me this_ /0 day of
- 20 ?,Z
Notary Public, State of Florida at Larger
When the just valuation of the structure for purpose of ad valorem taxation is equal to
or more than $300,000.00, and the building was not constructed with FBC nor a 1994
SFBC. Then you must provide a building application from a General Contractor for the
Roof to Wall connection Hurricane Mitigation.
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
RevOI 142021 Owner ofiidavit of exein ion >o'".,je, ( of 1