RF-12-22-3212 Inspection Affidavit 9525 NW 1 CtMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit # 1�111F _ IZ-22- 3212 DATE: 61-2� - WZ-5
INSPECTION AFFIDAVIT
f 2-0'.C(nc�O- C- KKSc�-o licensed as a(n) 6ntractor Engineer / Architect,
(Print name and circle License Type)
License #:
On or about e11-1&-Z0031 0=�0a-7 , I did personally inspect the roof deck nailing
(Date & time)
work at g6zs N W I C+ mi ami -eyl _ . 3315❑
(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)
Sign
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 a
Notary Public, State of Florida at La
day of a i is
�Y a"'w.JANIS
MI.
_
CLARISSA GUERRERO
Notary Public - State of Florida
Commission # HH 334763
a<n
My Comm. Expires Nov 21, 2026
R ,.Ind
.,...i.Rl N_.:_nai Notary Assn.
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