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Building &Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit # fmJ s • Qriri
1,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 rX) I did personally inspect the roof deck nailing
(Date)
work at: t�0Wy UL�
(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 triRge.
M- %SaTa1�
Signature a* Seal License #
STATE OF FL RQ SDA I _
COUNTY F V
Sw rn to and subscribed before this (§,Zl day of yr` 'CA)
bt'1(i\%0MV'W . Who is personally known to me or who has produced
as identification.
Notary Public, Stat of Flor' a
Signature of Notary.
Commission Number:
En
(Seal)
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