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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
Re: Permit #
licensed as a(n)Contractor*/Engineer/Architect
(Please int name & circle license type) *FS468 Building Inspector
*General, Building, Residential or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection.
On or about c�S%�/ , I did personally inspect the roof deck nailing
(Date)
work at: Du o Z—el
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of t da Existing Building Code Section 708 or the product approval submitted (whichever
is most.�
and Seal License #
STATVOF FLOA`
COUNTYOF
Notary Public, State of
Signature of Notary:_
Commission Number:.
LOP
6 20 /�?
e or who has produced
(Seal)