77 NW 100 TERRE: Permit
r.
' iat�le hores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: -! � Q 1 z6W
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I _ �O�Vky( 0.� ()�`e 1�` ,licensed as a ( Corttr�r �r Eng®166 Archi c'.Y
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(print name and circle License Type) FS 468 Building InspU P 4 u Y
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License #: CCC IM q
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INSPECTION AFFIDAVIT
On or about
(Date & lim_)
work at�-i Y'W (00 ,li l,ay�i
(Complete Job Site Address)
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1 did personally inspect the roof deck nalling
'P-L 53[so
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
County of Dade:
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 [ day of _ Ian. jo u
.� CHRI5��N
Notary Public, Sate of Florida at Large �illl :': ...: My �U-27g
���::issioH 2b 2oa�
EXPIRES: DeWnW
goad Thry NalurY PRrdAc Ut�deng
'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