HomeMy WebLinkAboutRoof AffidavitRe: Permit## 20C)11- 01 101
Public Works Department
Code Compliance Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2172 Fax: 772-462-6443
INSPECTION AFFIDAVIT
1,1c� L TW -.k licensed as a(n)Contractor*/Engineer/Architect
(Please int 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.
G L 1-
On or about %tJ�, I did personally inspect the roof deck nailing and/or
.(Date) (circle those that apply)
secondary water barrier work at:
(job site address)
Based upon that examination 1 have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
Signature and Seal
STATE OF FLORIDA
COUNTY OF 45 rt . Lu C -10 -
Sworn
e
hV 1 -2 2
License #
Sworn to and subscribed before me this oltVn day of O CN la Z V 20_2'o
by L..I oyot C 0 V C.1'01irrt' Who is personally known to me or who has produced
as identification.
Notary Public, State of Flopda
Signature of Notary:
Commission Number: C-1 C, 01-113-1 (Seal)
En 09/17/09
EEJJs--ASHLEY DEAN Public -State of Floridamission #� GG 978378 commission ExpiresApril 14, 2024