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Building& Code Regulation Division
r
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# reit -ag
I, licensed 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 468 F.S.to make such an inspection.
On or about (t—S L , I did personally inspect the roof deck nailing
(Date)
work at: 3q iQ(a A V -
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Flori xisting Building Code Section 708 or the product approval submitted (whichever
is most stri
�X162 �
Ig License IT
STATE OF FLORIDA
COUNTY OF � �
Sworn to and sub cribed before me this day of J00 2012
by 0. `q . Who is ersonally know me or who has produced
as identific
Notary' Public,State ofEforlda
Signature of Notary
Commission Number. (Seal)
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