RF-09-23-2358 Inspection Affidavit 1178 NE 99 StPermit # QXQ"Z-35 �
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
DATE:
INSPECTION AFFIDAVIT
,Ou"s 0 ` ko licensed as a(n 'Contractor Engineer / Architect,
(Print name and circle License Type)
License #: UL \�)Zb03Z
On or about L-L3�- --� , I did personally inspect the roof deck nailing
(Date &time) , I
work at I l� $ ��— CA T` _,CkO%_ SL(e' i �3
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurrica Mitigation 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 Z�-
day of %Q,VLo�!Ef-
Notary Public, State of Florida at Large -
ys JAVIER PUIG
z n_ Notary Public
a '--State of Florida
z Comm# HH084634
..�m
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Rev01 142021 Inspection Affidavit Page 1 of 1