RF-11-23-2915 Inspection Affidavit 125 NE 104 StUCEIVED
Miami Shores Village - BUILDING DEPARTMENT
Permit # F- ll-Z3 —�4is
10050 NE 2 Ave Miami Shores, FL 33138 NOV 1 7 2023
305-795-2204 www.msvfl.gov BY:
DATE: I 1
INSPECTION AFFIDAVIT
Ia v oS licensed as a(n) antracto. / Engineer / Architect,
(Print name and circle License Type)
License #: CCC, b GILL,`
On or about twnaw I did personally inspect the ro.of deck nailing
(Date & time)
work at �2-S 1,� i T FL
(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
Notary Public, State of Florida at La
Cry
day of
i� E
Notary Public - State of Florida
F Commission R HH 018940
z My Comm. Expires Jul 8, 2024
eorced through National Notary Assn.
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