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Building&Code Regulation Division
® 2300 Virginia Avenue
• r
Fort.Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# 1105 003 '
I,05CAP, , licensed as a(n) ontractor* Engineer/Architect
i (Please print 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.
I
i On or about JUI,YIt 0(0 W 19 , I did personally inspect the roof deck nailing
(Date) l'
work at: 0 Pe�� Lanb
(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 708 or the product approval submitted (whichever
is most strigent).
' 01;MA CCIC 1%1508
Signature and eal License#
STATE OF FLORIDA
COUNTY OF Sk IUC-1 e-
Sw ((n tw�o aaAn�dd sub-scribed before me this day of ' 20
i
by�J�•G�K t-{ZsZlt�l t Who is ersonally known to me or who has produced
as idents 'cation.
Notary Public,State of Florida ,
Signature of Notary: / f '
Commission Number: 1 (Seal)
i
j En EE-;
CLAUDIA CORTES
State of Florida-Notary Public
Commission #GG 178385
My Commission Expires
January 24, 2022
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