RF-10-22-2591 Inspection Affidavit 178 NE 111 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit# R F" /0— 2Z--239/
DATE: Q Z 2
INSPECTION AFFIDAVIT
licensed as a(n)Contractor/ Engineer/Architect,
(PrintAame and/circle License Type)
License #: CCC / 330s�'.S
On or about 0 zz z3 /. 3 Q A• , I did personally inspect the roof deck nailing
( (ate & time)'
work at / 79 /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)
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 -7 `" day of !'��-r ��%2�
1�
Notary Public, State of Florida at Large
}ava" °.- Hotary Publlc Stale of Florida
LAI Yinei Concepcion
K My Commission GG 963338
} 7afR Expires 02127/2024
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miShoresVillage
Rev01142021 Inspection Affidavit Page 1 of 1