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Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
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Re: Permit#
I, ,,e, licensed as a(n)Contractor*/Engineer/Architect
(Please pri name&circle license type) *FS468 Building Inspector
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*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to make such,an inspection.
0n or about off-cKr� // did personally inspect the roof dedk nailing
(Date)
work at: l ,I
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most stri I
S' nature and Seal License# i
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STATE OF FLORIDA j
COUNTY OF
Sw to and subscr' ed before me this 31� day o 20a
by ' t �%Ap ,Who is personally kn n tome or who has produced
` �� as identification.
Notary Public,State o rida
Signature of Notary:
Commission Number: (Seal)
En 01/19/2011
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