HomeMy WebLinkAboutRoof Inspection Affidavit planning& [?eve ptntent.S 5.
+ Regiltion aitii an
,300 Vir in�a si"
FortFierce,.FL 3498e
77 -;4fi2- 165 or 77 - &z _
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Fax, t 1
Rr OF INSPECTION Af PF'_? V T
Qottovan .
,. lid as a(nCotractor'jEngl :eer/Arcf�
(Pleas
- , print#name &c�rclelicense type) . . . _.. �
FS68 Suiatnit
g inspector
GenQra)►8a dd n9: esrderttfo!or Rna R Contractor cr or`l4dAidva!ce
n - rhed under,468FS.,tq�naiFexurh
err7nsptet�an
1 did ersonaliy inspg4,.jh roof'deck haitrrf
t ate}' --------
wairk at:
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�1cb site address.
Based upon filtat examination t have determined"thOnstaltatioh`was"dune accorci�ngto thecurrent
$. ,. C
edttianf the Flcic :Eiristin Bu�Iding Cade Sett�on 708 or the'product a provai subm�ttectM irhtrhever
CCCi3"Q489
g
rta and Sfrail lipensq# .
srATE QF 0,LC RIQA Palm B SG 1
Cc .unry.v
h
f� day of 20 �
Sworn to-and s�bscn
bed befaxe methis-�- c has `roduced
tNho:is ers�nally known to':me arw : P
b
Rsabert[3c�novan p
Y. :. as identification.
NOW' putific,State of Vitoria
(Sai}
S�grsature r+ f Notary
Canmisslor fsturnber
�,;G930t3t3.3 `
t. ceded