RF-09-23-2365 Inspection Affidavit 797 NE 94 StMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.ciov
Permit # R F— U — 3
DATE: i % f
l �
INSPECTION AFFIDAVIT
I VI Lea ) licensed as a(n Contract&,/ Engineer / Architect,
(Print name and circle License Type)
License #: CCC F2 7 3 3 U
On or about 3 3 fi , 1 did personally inspect the roof deck nailing
(D to & dim
work at --7e 17-7 &',,c _ � i s r;i'f c
(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 1, day of , C';?J�';.-
Notary Public, State of Florida at Large
Ei Notary Public Slate of Florida
Antony Joanem
I!!t MY Commission HN 371"S
Expires 3/10/2027
For Forms and Applications click here:
http://bldg.miamishoresviIlage.com/WebLink/Browse.aspx?id=118080&dbid=0&repo=Mia
miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1