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Public Works Department
Code Compliance Division
2300 Virginia Avenue
Fort Pierce, FL134982
772-462-2172 Fax:.772-462-6443
I
INSPECTION AFFIDAVIT
1
Re: Permit 4t/710
I, :&nV\ o licensed asa(n)Contracto */Engineer/Architect
(Please print name& circle licens type) *F uilding Inspector
*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.fo make such an inspection.
On or about IC)/D I did personally inspect the roof deck nailing and/or
(Date) (circle those that apply)
secondary water barrier work at: 0?5- Cu,-o�Gv) L/i F-4 l�I��'G�c�, /�(
` 3yS&�
(Job site 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.)
CCC_ i t-S3 t1 '0
Signature and Seal License#
i
STATE OF FLORIDPc-
COUNTYOF
Swo to nd subs ibed beforq me this day of LG�/ I' 20 1 7
by C \ Who is personally known to me or who has produced
as identification.
Notary Public,State of Florid
Signature of Notary:
Commission Number: ANGELA M HUFF
roe#nY � Notary Public-State of Florida
En 09/17/09 ?.*�; Commission FF 234730
My Comm.Expires May 27,2019
,,OF \°` Bended through National Notary Assn.