HomeMy WebLinkAboutRoof inspection aff 02/22/2917, 13:13; ._% STAPLES 0441 PAGE 02
Planning&Development Sentice5
Building&Code Regulation Division
® 2300 Virginia.Avenue
Fort Pierce,FL 34982
772-452-2165 or 7772-462-2172 _
Fox.772-462-6443 .
ROOF iNS ff CTl0K AFFIDAVIT
Re: Permit# L .'�- i rl..U I 0 S'to. _
I, �Q t ini. ' u 0licensed as a(n)Contractor*[Engineer/Arck►itect
(Please print name&circle licen a type) *F5468 Building Inspector
*denerol�building,Re90en6al or aofing T tractor r any individual certified under 4b8 FPS to make Such an inspection.
on or about I did personally.Inspect the roof deck nailing
(Date)
work at: 1 Z �'� W l4� t
S. iGt i" iLf �i±j �
(Job site address)
Rased upon that examination I ;ave determined the installatloh was done according to the current'-
edition of the.Florida Existing B IidingCode Section 6J:or-the product approval submitted (whichever is
most strigent). : .
6 -7 F%
Signature and SeW License_#
STATE OF ftpRitl
COUNTY OF- 2c,G 1
Sworn to anQ subscribed before me t iis,?i2 day.af kR L f- 20_Ll_,.
by , Who is personally known to me ar ho has produced
as-identification.
Notary public,State of Flori a �'�'� ,%P "TY PubHe R"ot'Fbdit
Signature of Nmryr: .-- CJ _ jasmin Orly
N 041,0081IMIS90ie18
Commission Number. �_� i3 (S _.
En 01/19/2011
RECEIVED Fff"L '2017
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