RF-01-23-4 Inspection Affidavit 578 NW 112 StPermit #_
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE: \ W 2'
INSPECTION AFFIDAVIT
�Q�-Vekz -� • a, licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: C c c
On or about �� 2412Q 23 , 1 did personally inspect the roof deck nailing
(Date & time)
work at 7 R lU W 1 12. Sr q II4-A ,1 3 31 (d [�
(Complete Job Site Address)
Based up ex minati I have determined the installation was done according to the
ne Miti a ' rofit 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 Z(0 day of o?�073
Notary Public, State of Florida at Large "
Noury Fk StaM 0 Flw"
&i�YM� 1Nas t 3601 D
Niy Co�WO"
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Rev01 142021 Inspection Affidavit Page 1 of 1