RF-10-23-2561 Inspection Affidavit 920 NE 100 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.gov
Permit# QF-ln-2°J-2S�j
DATE: 1 Z/OvW
INSPECTION AFFIDAVIT
licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: GcoI 33 24 ::�6
On or about Z tom( ! z0 Z5 , I did personally inspect the roof deck nailing
(Date & time)
work at 92-0 9j -,�3)39
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane
Signature
State of Florida, Miami Dade County:
I (Based on 553.844 F.S)
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
M
day of
�ece�►C�� 2023
Notary Public, State of Florida at Large `
For Forms and Applications click here:
http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01142021 Inspection Affidavit Page 1 of 1