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Regulation0.04BuildIng & Code Division
2300 Virginia Avenue
Furrtt Pierce, FL 349$2
772-462-21fi5 ar 772-4fi2-2172
Fax:
ROOF INSPECTION AFFIDAVIT
Re: Permit #
�, Christopher Collins
oil
(Please Print na me &circle license type)
tensed aS a(n)Contractor*/Engineer/Architect
*F5468 Building Inspector
141 All,
�Yl - such c;n,1n_1;pcc ion.t6or 1 0 O_ any inwi-erb) lie. un, AGenere Slul o' R yp I r rt fq iI J fi, esimw iaI 00ij.9itf lll6 0 0-
,O -n or about
work at:
.r
It lot 1&119
--M6 JOIL
Signa
;TATE 0 F FLO R [ DA
COUNTY OF 'dC .0 d
Sworn to aInd
bys1!
caminatio
da E
inspect
did personaIly the goof deck nailin
(Job site address)
1 have determined the installation was done according to the current
Building Code Section 611 or the productapprovald (wF�ichever 4 subm6ltte-is
CCC -05801-1
License #
ubscribled before me this day of
A Who is personal I V k nown to
as identification.
Notary Public, State of FIori
ir�gature of Notary..
Commis-'sion Number-,
En 4119/2011
20��
e or who has produced
(Seal)
NOTARY PU;5
STATE, OF F
f: GG2
Expires 211
LIC
ORIDA
712023
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