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- = Building & Code Regulation Division
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Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit # 2) O Z- 013p
Christopher Collins 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 03 C)3 202 I I did personally inspect the roof deck nailing
(Date)
work at: Jaoap 6 zr l�Qlr q 0 Y-., F4 , P12`�CP .
(lob site address)
B a s upon th)texamination I have determined the installation was done according to the current
e tion of th rida Existing Building Code Section 708 or the product approval submitted (whichever
his most s
CCC-058011
Signature and Seal License #
STATE OF FLORIDA COUNTY OF { L
ZUrj'�'
Swo��n� to n sub cr-bed before me this day of 1- 20_U
by L �" "is� who is personally known to me or who has produced
as identification.
Notary Public, State of Flo
Signature of Notary: 91A�'
Commission Number: Z (Seal)
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