HomeMy WebLinkAboutVan Schepen Affidavit.pdfC
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Planning & Development Services
Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-216S or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit # 2I0I �04910
I,
licensed as a(n)Contractor*/Enginee r/Architect
(Please print 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.
On or about ! 2 1 f , I did personally inspect the roof deck nailing;
(Date) �,
work at: q �� � v&
(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 708 or the product approval submitted (whichever
is most strigent).
Signatu a and Seal
STATE OF FLORID
COUNTY OF N 1UNL_
CW ,3210-1-
License #
Sworn to and subscribed before me this day of _ 202-1,
by ,D" VT) �, ' �%' Who is personally k o n to me or ho has produced
as identification.
Notary Public, State of FI
Signature of Notary: —
Commission Number:
En
Notary Public State of Florida
al arnela Jones
r My Commission GG 98547o
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