RF-11-23-2828 Inspection Affidavit 565 Grand ConcourseMiami Shores Village - BUILDING DEPARTMENT
10050 NE 2 Ave Miami Shores, FL 33138
305-795-2204 www.msvfl.ciov
Permit#
DATE: 1112 �1Z a
INSPECTION AFFIDAVIT
�licensed as a(n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #: C G� 1 ,5-z 3 3
On or about /1 &-/Z-o 2's 2 •rDOP -"I , I did personally inspect the roof deck nailing
_ (Date & time)
work at �� � 4��r.,'} Gn,vc 01,r.z.i E. /ri /Al, s S L 3 3 3
(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 j 7 ter day of Ala6'Y�4K � 3
Notary Public, State of Florida at Large
05G q :'
i 1 Dd pvGdc u a t';C�Op!k7��
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miShoresVillage
Rev01 142021 Inspection Affidavit Page 1 of 1