RF-02-23-326 Inspection Affidavit 175 NW 109 StS%(RES� Miami Shores Village - BUILDING DEPARTMENT
94
�1 �k �P 10050 NE 2 Ave Miami Shores, FL 33138
IV � a; 305-795-2204 w. fl.gov
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Permit # DATE:aZZ22 / 3
INSPECTION AFFIDAVIT
(AMale Wo licensed as a(n) Contractor / Engineer / Architect,
(Print name an circle License e)
License #: / 3 22 l2 f Z -
On or about t] ' 35N� , I did personally inspect the roof deck nailing
( to & ti e} _
work at--S�J /dl"��
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane M' 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 0 day of
Notary Public, State of Florida at Large
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For Forms and Applications click here:
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