RF-02-23-447 Inspection Affidavit 568 NE 102 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # kr-02-2-3-4w�
DATE: Zv & 0 2 Z 3
INSPECTION AFFIDAVIT
licensed as a ) Contractor Engineer / Architect,
(Print name and circle License Type)
License #: me, OS-V
On or about k , I did personally inspect the roof deck nailing
(Date & time) p
work at �66 F C& . I 0 Z. �T-_
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation
Signature
State of Florida, Miami Dade County:
ed on 553.844 F.S)
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
Notary Public, State of Florida at La
1�4A rvt
day ofZ423
of Florida
PaWda Barnes
My Commission HH 143540
Expires 08/13/2025
For Forms and Applications click here:
http://bidg.miamishoresvil lage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
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