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Planning& Development Services
,f Building& Code Regulation DIVIs* _
2300 Virginia Avenue ECEIV9b
o Fort Pierce, FL 34982 �P 1 1 2019
772-462-2165 or 772-462-2172
Fax: 772-462-6443 [ST:Luc:ie County, Permitting
ROOF INSPECTION AFFIDAVIT
Re: Permit# No I^ COC/5-
1, OAP, licensed as a(n)Contractor*/Engineer/Architect
(Please print nam 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 �— Z�! , I did personally inspect the roof deck nailing
(Date)
work at: I's-0o p(AU(-r)+1
(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 most3t
Signature and Se License#
STATE OF FLORI
COUNTY OF
SwPrn o and subsc i ed�fore me this In day of 20L9
by ��� ) . Who is personally knowh to me or who has produced
as identification.
Notary Public,State of F id
Signature of Notary: �Avpue BRANDY MOORE
Commission Number: O Ci � M Commisslon#GG 102839
Nr r Explres May 9,2021
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