RF-05-20-966 INSPECTION AFFIDAVITMiami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RE: Permit #w Z �— —0- 2-0; [e[o
INSPECTION AFFIDAVIT
DATE: S1202-
i LCLEA 0 f-I-A t.A LI2 licensed as a (n) Contractor / Engineer I Architect,
(Print name and circle License Type)
License M C ('_C. (32 `a 3 01
On or about
(Date & time)
(Complete Job Site Address)
FS 468 Building Inspector
I did personally inspect the raaf deck naifirig
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based on 553.844 F.)
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 I Ult " ay of 7—aZ-v
r ...;� CANDY CABOVEME
Notary Public, Sate of Florida at Large ` _ MY COrA115 Iat; . cc 034505
- - EXPIRES: September29, 2020
E�rd[C'r a i:b,ar; Pdb,.cUadeerrti;e(;
'General, Building, Residential, or Rooring Contractors or any individual cartlried under468 F.S. to make such an Inspection. Include photographs of each plane of the roof with
permit # and address # deady shown marked on the deck for each inspection
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