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Building&Code Regulation Division
'Lilllg
2300 Virginia Avenue
Fort,Pierce, FL 34982
772-462-2165;or 772-4.62-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#. x$01-' GGC l 33 ( ( D
I, 'Ll.-oAA IfYh4y licensed as a(n Contractor* Engineer/Architect Roof 06
(Please print name&circie'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 `� 7' �� I did personally inspect the roof deck nailing
(Date).
work at: b� Sort W �Uoe,
(Job site addre s)
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).
CCC 133 11
gnature and Seal License#
STATE OF FlORIDA—
�� ��
COUNTY OF 1
Sworn to and subscribed before me this. l day of ZIJ`l 20_
by Who is personally known to me or who has produced
ehffela Gf CO.��:2_ as identification.
Notary Public,State of Florida
Signature of Notary:
Commission Number: -.-2-o-.6 y (Seal)
En �v""'�. Notary Public State of Flonda
Isiah Jorgenson
My Commismoh GG Ex 209824
iro 04122/2 22
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