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f
i Building & Code Regulation Division
2300 Virginia Avenue
F Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit #I d " V—za#
as a(n)Contractor*/Engineer/Architect
(Please print name & circle license type) *FS468 Building Inspector
*General, Building, Residential or Roofing Contractor or any individual certified under 458 F.S. to make such an inspection.
On or about � I12,01 , I did personally inspect the roof deck nailing
(Date)
work at: 74 (y -176k e4lrc -TelwmcG-
site ddress)
Based upon that examin
edition of the F a Existi
is most s . ent).
gna
STATE OF FLO IDA
COUNTY OF " !—
have deter Ined the installation was done according to the current
uilding de Section 708 or the product approval submitted (whichever
�L C'
License #
Sworn to and subscribed before me this / day of �20li�
by �(tcR�: �Ci' �'��r who is personally known to me or who has produced
as identification: -
Notary Public, Stat f I rida
Signature of Nota
Commission Number: A `fU `fit (Seal)
En
Et
A MARIE MONTELEONEryPublic-StateofFloridammission GG 190497omm.
Expires Feb 27.2022ough
National Notary Assn,