Coronavirus Disease 2019 (COVID-19)
Threshold Building Construction Site Procedures
Coronavirus Disease 2019 (COVID-19)
Inspections by Affidavit for Occupied Spaces
REV 07/2/20 INSPECTIONS BY AFFIDAVIT FOR OCCUPIED SPACES | Planning & Development
COVID‐19TEMPORARYRELIEFMEASURE
INSPECTIONBYAFFIDAVITFOROCCUPIEDSPACES
PROJECTINFORMATION
ProjectNumber:
ProjectAddress:
ScopeofWork:
VERIFICATION
IherebycertifythatIamaregisteredArchitectand/orEngineerandthatIpersonallyinspectedthepremisesat
the project address listed above on the date of this statement. In my professional opinion, based on my
knowledge,information,andbelief,Ihavedeterminedtheworkperformedmeetstheminimumrequirements
setforthintheFloridaBuildingCode.IalsounderstandthatIwillonlyusethisaffidavitduringtheCOVID‐19
Emergencyperiod.
IhaveuploadedtherequiredphotodocumentationtotheAccelarecord.
Date:
______________________________
LicenseNo.:
____________________________
___________________________________ ______________________________________
LicenseHolderName(Printed)

LicenseHolderName(Signature)
___________________________________
DigitalSignature
NOTE:NotaryisrequirediftheVERIFICATIONisnotdigitallysigned.
STATEOFFLORIDA
COUNTYOF________________________________
Swornto(oraffirmed)andsubscribedbeforemebymeansof
physicalpresenceoronlinenotarization,this_______dayof
_________,__________,by_____________________________.
_____________________________________________________
SignatureofNotaryPublic–StateofFlorida
_____________________________________________________
Print,Type,orStampCommissionedNameofNotaryPublic
PersonallyKnownORProducedIdentification
TypeofIdentificationProduced:_______________________
Affix Notary Seal
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome