RF-01-19-28 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 #Y P1�--0 1- a-2,0
INSPECTION AFFIDAVIT
DATE: %/ 2-SD (I
licensed as a () ConDragineer / Architect,
(Print name and circle License Typo) FS 468 Building Ins ector
License #:
On or about _ I did personally inspect the root deck naiiinq
(Date & time)
work at Vo N qrJ 5� M i►r M i 5} {] C—� , �-- 33I��j
(Complete Job Site Address)
Based upon that examination I have determined the installation was done according to the Hurricane Mitigation Retrofit
Manual (Based W 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 of4� 10tg _
;F Marl�eol BrenaPubW taro of Florlde
` Notary Public, Sate of Florida at Large '� w n'e oz° 2s,o'4
'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 # cleany shown marked on the deck for each inspection