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! = .�.� Building&Code Regulation Division
2300 Virginia Avenue
4 Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# 2010-0027
i, Daniel Simmons , licensed as a( Contractor)/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building Residential or Roofing Contactor or any individual certified under 468 F.S.to make such an inspection.
On or about I � i did personally inspect the roof deck nailing
(Date)
work at: 8201 S Indian River Dr Ft Pierce 34982
(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 611 or the product approval submitted (whichever is
most MM-
RC0052013
Signature and Seal License#
STATE OF FLO
COUNTY OF
Sworn to and subscribed before me this )I day of 200L)
by Who is personally known to me.or who has produced
U as identification.
Notary Public,State o Florida ., �� zl ,t 1
Signature of Notary: .�
Commission Number: IP(Seal)
Je
it
En 01/19/2011 :N. State Flared
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wry Commission Nm GG 9462V