HomeMy WebLinkAboutSt. Lucie Roof Inspection Affidavit 148 NE Bracken Dr 20210326 2-Sealed.pdfPlanning & Development Services
Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit #________________
I, ________________, 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 ____________________, I did personally inspect the roof deck nailing
(Date)
work at: _____________________________________________________.
(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 ϳϬϴ or the product approval submitted (whichever
is most strigent).
___________________________________ ________________________________
Signature and Seal License #
STATE OF FLORIDA
COUNTY OF _________________
Sworn to and subscribed before me this ________ day of _________________ 20___,
by ____________________________. Who is personally known to me or who has produced
______________________________ as identification.
Notary Public, State of Florida
Signature of Notary:____________________________________________
Commission Number: _______________________________ (Seal)
En
SLC - 2103-0611
Richard Leon Cannyn
03/26/2021
148 NE Bracken Dr., Port St. Lucie, FL 34983
PE # 65994