HomeMy WebLinkAboutRoof Affidavit ,� -
Planning& Development Services
Building&Code Regulation Division
0OLT 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;Sgb Lj a 5V
�(0ensed 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 R5.to make such on inspection.
On or about (--�g-`,)o 1!5 , Vdid personally inspect the roof deck nailing
(Date)
work at:(-e i tkyg-`�c,ayc, t I wcl-e CS' 14c,e- Ft .3 q9 k2
(Job site address)
Based upon that exami a det rmined the installation was done according to the current
edition of the Fl ' a Existi uilding. de Section 708 or.the product approval submitted (whichever
is most str' nt).
j331o2z01
gnature and S License#
STATE OF FLORIDA
COUNTY OF<S`r
Sworn to and subscribed before me this day of �S20�
by�hQQ c`.k1 hY-0CJG'A/ Who is personally known to meteor who has produced
as identification.
Notary Public,Star%-
Signature of Nota
Commission Number: �. (Seal)
En
+�*aYat ., LISA MARIE MONTELEONE
,t,'Ai. Notary Public-State ofFlorida
Commission 9 GG 190497
iF We' M Comm.Expires Feb 27.2022
,or nom,.' Y
"Bonded through National Notary Assn.