RF-03-22-714 Inspection Affidavit 935 NE 99 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.rmsvfl.gov
Permit # RF-03 --as --7"/
J-0,1 Bus+os
DATE: ( (P 12-S
INSPECTION AFFIDAVIT
(Print name and circle License Type)
License #:
licensed as a(n • Count t r ngineer / Architect,
On or about 'L I 1.-)-3 1 did personally inspect the roof deck nailing
(Date & time)
workat 9';5 �Y—, 991 �t. i-�laml SLtOrC3 ,_F/ �3U
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane MitLgation Retrofit 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
1(45?
day of br G[ ,mac
Notary Public, State of Florida at Large ALZLN
�a,) •'U Notary Public State of Florida
s Nicolette S Gooden
My Commission HH 146322
OFf�d4� Expires 06/28/2025
For Forms and Applications click here:
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miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1