HomeMy WebLinkAboutRoof Inspection Affidavit Planning& Development Services
jN Building&Code Regulation Division
2300 Virginia Avenue
D Fort Pierce, FL 34982
- = - „� --=--� - - � �>- 772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# 2-003 _Ho 2-
1,
I, OU licensed as a(n)Contractor*/Engineer/Architect
(Please print na#b&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 nailine
(Date)
work at:
(Job site address)
Based upon that examination I have determined the installation was done according to the current
editio Florida Existing Building Code Section 708 or the product approval submitted (whichever
is ost st n .
Signature and S License #
STATE OF FLORIDA,
COUNTYOF ' v�q(
Sworn tan subsc 'bed for me this ' day of " ' � ' (C/20
by �� e . Who is personally known to me or Vgho has produced
='d
ficati
Notary Public,State Signature of Notary: r q
Commission Number: N41(-T'4 A F1 MnLU I r (Seal)
x Q N.fN,CON,INIISSION4GG168796
EXKRES:December 17,2021 5
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