RF-11-22-2892 Inspection Affidavit 739 NE 94 StPermit # IMF-11 - z2 - .2892
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.-Qov
DATE: 12a 2.3
INSPECTION AFFIDAVIT
licensed as a( Contractor Engineer /Architect,
(Print name and circle License Type)
License #: C.C, C c�33b 9 l
On or about j 1% I did personally inspect the roof deck nailing
(Date &time)
work at `�39 v-,z 9 4 --A i Slr, s. �L. .33► 3x
(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)
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 . _ day of r
Notary Public, State of Florida at Large
�..• : ��.,, GISELLE T. VIC_ENr- I�i
F R' Notary Public -State of Florid:;i Z
Commission FW 55032
y; r
' My Commission Expires
s October 20, 2024
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