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Plann*ing Development Services
Building &Cod e Reg ulation Di�isi�n
2 300 Virginia Avenue
Fort Pierce, FL 34982
772-462-Z1fi5 or 772..a -462m2172
fax: 772-462-6443
ROOF INSPE ION AFFIDAVIT
�r Christopher Co"119ins- li
(Please print name &circle license tvnaj
tensed as a(n)Contractor*/Engin,eler/Arch,i'tect
*F5468 Building InspeCtv r
*Generol* Suilffing, ,R e-siderrt'��I or Rcx?fjng Con troctor or any indivrduai certrfa`ed -un, Gfe r 4 68 F. ,. to fnake su,�P' c �,rasP�����r�.
1-n or a bo • .mom
work at.
did personally inspect the rood deck na
(106 site address)
STATE OF FLO, A
COUNTY OF l LU Ct C-1.1
Sworn t
by PIA
CCC -Q5$011
License #
o a n d s lJbscrfbed before me th
16
NNotaryPuI icI State o
Signature of Notary:.
Commission Member:
En- 01/19/2011
L Who is personally known ''o me o�r16 hD haS Drod uced
as identificati'0111.
f Florida
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(seal)
k"M Hoy
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Expires 211712023
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