HomeMy WebLinkAboutSLC-2004-0118 affidavit_0001---_ ----- ----. Planning &. Development Services
Building & Code Regulation Division
F 2300 Virginia Avenue
For€ Pierce, FL 34982
- - -- = _- -- e72-462-2165 or 7724-62-21 e 2
- — -- — Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit #. S L \ — c-0 C (0 ( ( 3
licensed as a(n)Contractor*/Engineer/Architect
(Please print name & circle fic6se type) 'FS468 Building Inspector
'General, Building, Residential or Roofing Contractor or any individual certified under 468 Fi to make such an inspection.
en
On or about f Q ! I did personally inspect the roof deck nailing?
(Date)
work at: Q
(Job site address) 1
Based upon that examination I have determined the installation was done according to the current
S
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most strigent).
l Signature and Seal License #
STATE OF FLORIDA i
COUNTY OF
Sworn togtogj s4bscrib d before me this / day of t" t 20 O
by S- Ce Who Is personalty known to me or who has produced
as identification.
Notary Public, State of Florida /)
Signature of Notary:
Commission Number. (Seal)
En 01/19/2011
VIRStephen P. Frederick
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG048393
Expires 1127/2021