RF-06-20-1314 INSP AFFIDAVITCC— 0(0— 1z r % 3 I y
RE Permit # __._
�= rl name and circle License Type)
License #: C (-•C-- l 3 3�) t U
r-
lami � hores Village
Building Departtent
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DATE: I — 6 ` Zti
INSPECTION AFFIDAVIT
licensed as a (n) Contractor / Engineer / Architect.
FS 468 Building Inspector
On or about -` [ , ^%i0T] I did personally inspect the roof dear naiiina
work at
(,:o117ol=+.p Jco Sile Address)
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 Dada:
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 1 _day of
Cassandra Goss
Notary Public
Notary Public, Sate of Florida at Large i' (�' state of Florida
�t Comm. Expires 10/31/2020
Commission No, QQ 43572
'Goie,a Eoiljw . - E,dCnf r Ro, i, ; ar^n s ar., ir,draoes! cerbLed under 468 F S f:7 rake e,:ch an inspect on Include pholepraphs of each plane of roof ,vdh
pe,mit # and address = Gleamy shown ma rdeo on thfl dec , for enp inspechc
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