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Building&Code Regulation Division
2300 Virginia Avenue
MMMOMIZ 1k Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT =RECEIVEDRe: Permit# jQQ�6�(':Y
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I, Cep-cry , licensed as a( Contractor* ngineer/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 I did personally inspect the roof deck nailing
(Date)
work at: '79' F2& LL=ae&4 Lr�M
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the F ' a g Building Code Section 708 or the product approval submitted (whichever
is most st� t).
Signature and Seal License#
STATE OF FLORJ)
COUNTY OF r
Swor o and sub ribe before me this da f 204-�
by,-TM, Irl Who is pers ally known to me or who has produced
as identification.
Notary, i , �Flr Signature of Not
Commission Number: (Seal)
En
NYPPI
1/" KAREN S. NIELSEN
=c�P `R'" State of Florida Notary Public
•= Commission # GG 207484
My Commission Expires
,,,,� June 12, 2022