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RF-10-23-2587 Inspection Affidavit 320 NE 100 St
Permit # 1`l` Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov nib -lo-23-C�58} DATE: ) �/) J / 23 INSPECTION AFFIDAVIT GA)ky t4kF ! Ep- licensed as a(n) 6ntritor / Engineer / Architect, (Print n me and circle License Type) License #: -1 C 15 ) ©� 3 GC,3331 o G On or about , I did personally inspect the roof deck nailing (Date &time) workat {aa fV loo'51Sit, H'Irtn,'I 5HOY-eS, f=� 3)3b' omplete Job Site Address) Based up, n that examinationAave determined the installation was done according to the 7ica,;1iti),ation Signature Manual (Based on 553.844 F.S) 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 'I �LV%^ day of Dcc&— nbe�- 20a3- 1�q[11l11�1l1111j `tom\ 1111 ,p1NE Q1�.,,frrl Notary Public, State of Florida at Large *•�a1QH''•.� �Isa3aa� Atl sir "ypy •:n5�• �.,�� 141011,1111111110 � �l1C. I TX `\ For Forms and Applications click here: http://bldg.miamishoresvillage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia miShoresVillage Rev01 142021 Inspection Affidavit Paqe 1 of 1