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Building & Code Regulation Division
%moLiLIN 1'y 2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit # SLC 2004-0134
I, K P44w , licensed 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 F.S. to make such an inspection.
On or about 05/27/2002 1 did personally inspect the roof deck nailing
(Date)
work at:
611 Willows Avenue, Port St Lucie, FL 34952
(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 most strigent).
Signature and Seal
STATE OF FLO%_ ^^^
COUNTY OF �y
S wom to and's s ib Ifte fo e this day of
b Who is personally known to
as k�--lttificatio@. I, -
Notary
Notary Public, State of FI
Signature of Notary:_
Commission Number:
En
CCC1332349
License #
20—;?<—D
who has produced
(Seal)
i.K]
00'W ate of Florida`4, nGG 241967
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