HomeMy WebLinkAboutRoof Sheathing AffidavitPlanning & Clevelapment Services
Building & Code Regulation Division
2300 Virginia Avenue
Fart Pierce, FL 34982
772-462-2165 or 772-462.2272
Fax: 772-4E2-6443
ROOF INSPECTION AFFIDAVIT
Re, Permit # SIC 2011-0351
1, Andrew Keys licensed as a(n)Contractor*/Engineer/Architect
(please print name & circle license type) *FS468 Building Inspector
*General guilding, Resfdendai or Raoft Contrarrarorany ft?dWoofcertifxeduftdfrd69FS to Make Such oil Inspectton.
On or about 11123/2020 .1 did personalty inspect the roof deck_ naiiint€
(Date) - - - -
work at: 1 623 8 Indian River Dr ,Jensen Beach, FL 34957
(job site address)
Based upon that examination i have determined the installation was dome according to the current
edition of the Florida Existing Building Code Section 708 or the product approval submitted (whichever
is most strigant)-
Signature and Seal
CCC 1331638
License #
STATE OF F til
COUNTY OF -
s n to a d subscri b-e:d efo a me thi of 20s`--+'
Y%Who is6iy
allyr known to Meer who has prod i
as Wentification.
No41y ubl1cP,-tate�ta fi�orlda i
Signatureof Notary --
Commission Number. (Seal)
En
�h 151 •: r
......... r.
MY MAW MR
_ JAN 03, 2021 =
f{,ffOF IF4 5x,.
ao
The Foregoing instfUML%nt was acltnOviledged
before mt-bymearts of4Q Physical Presence
or ElOriW a Notarization,