RF-18-1630 (2)Miami Shores Vinage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit # //
Cr S� 11'�lJ 7 DATE: 6,/l
A_9(1.,f))9)/.
INSPECTION AFFIDAVIT
r--
F�'LfL� 1-eS licensed as a (n) Contractor / Engineer / Architect,
(Print name and circle License Type)
License #:
On or about
ate & time)
work atC2 S 7s
(Complete Job Site Address)
FS 468 Building Inspector
, I did personally inspect the roof deck nailing
5A/0-71-cam c
B ed upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Ma I (Based on 553.844 F.S)
/Cr
Signature
State of Florida
County of Dade:
The undersigned, being the first duly swom, deposes and says that he/she is the contractor for the above property
mentioned.
Swom to and subscribed before me this / g
Notary Public, Sate of Florida at Large
day of cioC `a
'General, Building, Residential, or Roofing Contractors or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with
permit # and address # clearly shown marked on the deck for each inspection
Ontucnr1 nn (71111/1111 A 14P)111MO