RF-01-23-259 Inspection Affidavit 141 NW 100 TerrMiami Shores Village - BUILDING DEPARTMENT
cc 10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl. ov
fro RI"D
Permit # 02 3- o'i 5�9 DATE: D 2 I 0 j 1 Z L' 2-
INSPECTION AFFIDAVIT
licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle Licen Type)
License #: UC,133aJ kY
On or about )Z 1 0 f Zo Z 1 did personally inspect the roof deck nailing
Date time)
work at 1 4// n1 .0 _I � a 1 C r-ra &C g1 ,'(In' J a-3 L �
(Complete Job Site Address)
Based upon th a inat' n I have determined the installation was done according to the
Hurricane ltigatio Retr it Manual (Based on 553.844 F.S)
Signature
State of Florida, Miarhi Da4e 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 D �1 day of LKLI 4 r - 2-0 23
Notary Public, State of Florida at Large
canto. can km Emkpm
Notary Public
State of Florida
W Comm# HH090143
ti�E �y�o Expires 2/8/2025
For Forms and Applications click here:
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miShoresVillage
RevOI 142021 Inspection Affidavit Page 1 of 1