HomeMy WebLinkAboutInspection Affidavit1
Public Works Department
Code Compliance Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2172 Fax:772-462-6443
INSPECTION AFFIDAVIT
Re: Permit # k1 NI-0 5`NA
I, l V— licensed as a(n) ntractor* Engineer/Architect
(Please prin name & circle license type) *FS468 !ding Inspector
*General, Building, Residential or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection.
i
On or about I I did personally inspect the roof deck nailing and/or
(Date) (circle those that apply)
secondary water barrier work at: -QI ID AJ
(Job site address)
Based upon that examination I have determined the installation was done according to the
I "
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
License #
STATE OF FLORID,�,—- � C f�
COUNTY OF ��1,,,,
Sworn t and ubscribed before a his day of Prr 20�
by Who is personally kno a or who has produced
as identification.
Notary Public, State of Flori
Signature of Notary:
Commission Number.
En 09/17/09
W"a 11 Janett Miles
m6y Fublic• State of Florida
r Comm asion#GG51833
Expires 11/30/2020