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Building&Code Regulation Division
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2300 Virginia Avenue
COILAIM 1 .1 Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#
1, Rod V61 U r , licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building,Residential for Roofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about l 1 �� L 2-o 4 . 1 did personally inspect the roof deck nailing
(Date) (n�
work at: 17`40 10. �7 ` 5k i't rC �� 3 9,qq�
(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 mot strigent)-.
�Wc (� 0 C C 13z 720 ?
Signature anh Seal License#
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STATE OF FLORIDA/
COUNTYOF.
Swor o arld subscribed before me this 2 3r day of �441yeA r�/ 20�
by 0 OL W Lo`��e Who is personally known to me or who has produced
as identification.
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Notary Public,State of FI r da
Signature of Notary: ,G�e^ RE
ate of Florida
Commission Number: GG 238873
020
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