RF-07-20-1429 INSP AFFIDAVITRE: Permit # n •- �� r �� Q
INSPECTION AFFIDAVIT
iami .: hores illage
ildeng �7epartment
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE- IIto VLO-34
I 1 license-d as a ( �trac1 Engineer 1 Architect.
(print name and circle License Type) FS 468 Building Inspector
License
On or about�fl�� - ��'•� I did personally inspect the roof deck neilino
;Date 8 tine)
work a, \p�. _\\6\V\ Yli,
(Complete Job Site Address)
11
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 undersigneC, 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 I
A9��2Zp
Notary Public, Sate of Florida at Large _ +,'t..: 1SAAVNDA FERNANDEZ
= State of Florida -Notary Public
`• Commission N GG 218666
My Commission Expires
May 16, 2022
'General, Bwloing, Resicenlial. or Roofing Conlractors or any individual certified under,16E F ; to make such an inspection
peiriiil « and address # c early shown marked on il•e deck tor each inspection