RF-11-22-2816 Inspection Affidavit 1055 NE 96 Stt�
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Permit # LL - �1-u~�' �6
Miami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.ciov
DATE:
INSPECTION AFFIDAVIT
I j ,� ale licensed as a( Contractor /'jEngineer / Architect,
(Print name and circle License Type)
License #: C ,(-r, P)71, _00-31
On or about cyN , I did personally inspect the roof deck nailing
(Date & time)
work at W) 5� N`_ C( 6 S
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane 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 7� _ _day of ky-'!J4 T 0Z3
Notary Public, State of Florida at Large
a►F YeBnsiUery. Escobst-
�:• Comm.#H}��48164
Expires:Sept.e 29, 2024wed ft Am No
tly
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1