RF-02-23-355 Inspection Affidavit 30 NW 107 St�14 0 R I ID
FF 23-355
Permit #"D' - 02-
I
(Print name and circle License Type)
License 4: cccl 333931
On or about
DATE: 04/03/2023
licensed as a(n)4❑i�tractor / Engineer / Architect,
(Date & time)
work -at30 NW 107 ST Miami Shores, FL 33130
I did personally inspect the roof deck nailing
(Complete Job Site Address)
used upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.5)
Signature
State of Florida, Miami Dade County:
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 3
Notary Public, State of Florida at Large
day of Apl-t'l 0 a-
V016".el PtV
Karen C Z S
)46?2025
# �flavp I
commission rxPres 10-26
l3ofind Chriough • CynanulM
I I C�* Florida - Notary Public
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