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- ,__ Building & Code Regulation Division
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.�� 2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit # 2102-0040
Mauricio Orellana licensed as a(n)Contractor*/Engineer/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 218121 , 1 did personally inspect the roof deck nailing
(Date)
work at: 6747 Dickinson Terrace Port St Lucie FI 34952
(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).
V%IA-Z Cj-' 0 0iffliv, a,
Signature and Seal
STATE OF FLORIDA
COUNTY OF st lucie
CCC- 1330623
License #
Sworn to anj subscribed before me this <3 day of k 2O''
by v - v � C c Q (3dC . Who is personally known to me or who has produced
`\)r 1. C as identificat' n
Notary Public, State of FI ri
Signature of Notary:
Commission Number: (Seal)
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