HomeMy WebLinkAboutINSPECTION AFFIDAVITPublic Works Department
Code Compliance Division
2300 Virginia Avenue
Ft. Piercej•FL 34982-5652
INSPECTION AFFIDAVIT
RE: Permit # /` �(� 0,/J:U�
I p upil l jrL licensed as a(n) Contractor*/Engineer/Architect/
(Please p'nt name and circle'license type) FS 468 Building Inspector*
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection. All affidavits must include photographs of each plane of the roof with the permit # or address # clearly
shown marked on the deck for each inspection.
On or about UZv l>;l , I did personally inspect the roo
(Date & ti
deck nailin and/ r seconddr water barri workat�-
circle one (Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
1144Lilf"4t &
Signati& & Seal License #
STATE OF FLORIDA
COUNTY OF 5��3n}1—
Sworn to and subscribed before me this day of . 20gL
Who is personally known or who has produced
as identification.
NOTARY PUBLIC -STATE OF FLORIDA
" Karen S, Nielsen
Notary Public, State of Florida Comtnission#DD1000358
Expires: JTL'NE 12, 2014
Signature o BONDED THRU ATLANTIC BONDING CO., INC.
Commission No.� =�;?�
(Seal)
cml 9/27/07