RF-03-23-725 Inspection Affidavit 855 NE 91 TerMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
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DATE /5- /ao'-) 3
INSPECTION AFFIDAVIT
I coa licensed as a(n) =ontractor/ Engineer / Architect,
(Print name and circle License Type)
License #: GC61 �7,233
On or about
(Date & time)
work at Y.'S-J Abc, q1 7671
I did personally inspect the roof deck nailing
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigatign Rgtrofit 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 day of ,
:,iItIF���s���
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Notary Public, State of Florida at Large
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miShoresVillage
Rev01 142021 Inspection Affidavit
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