HomeMy WebLinkAboutUntitled Public Works Department
^= Code Compliance Division
2300 Virginia Avenue
• R I . A Fort Pierce, FL 34982
772-462-2172 Fax: 772-462-6443
INSPECTION AFFIDAVIT
Re: Permit# ] 7 / O 0
I, R1r_ylar d. W 't'V'CtChuk_ , licensed as a(nContractor /Engineer/Architect
(Please print name&circle license type) *FS468 ui ing Inspector
*General,Building,Residential or Roofing contractor or any individual certified under 468 F.S.to make such an inspection.
On or about Z I did personally inspect the roof deck nailing and/or
(Date) (circle those that apply)
secondary water barrier' ork at: cd96 h _ad=lay-V_ In. RSA. EL 349 5�L. .
(lob 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.)
C/
Signature and Seal License#
STATE OF FLORIDA JA
COUNTY OF
Swor to and subscribed fo me this day of 20-LI.
by k i cba ca �i'�t.0 son nown me or who has produced
q
as identification.
Notary Public,State of Florida
Signature of Notary:
Commission Number: 4�iSeal)
En 09/17/09
+'>'• AUDREY B.HUMPHREY
�O• .p
MEXPIRES COMMISSION
F6,20192
undaror0ers
Bonded Thru Notary Public