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Building&CodeRegulation Division
2340 Virginia Avenue
s Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# /..:5 05 -0 y3
i, c G� G t iv a /}- 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 (4nf- I did personally inspect the roof deck nailing
(Date), j
work at: / 0 A�-j e- die,
(Job site address)
'Based upon thatexamination.t-have determined-the installation was done according to the cOrrent.
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most str' nt).
License#
Signature and Seal
STATE OF FLORIDA
COUNTY OF
Sw a and sub r efore met hi
day o€ 20
b who is personally known to me or who has produced
s identification.
N�tBry Public,State of
Signature of Notary: r (Seal)
Commission Number:
pubic state of Fiorida
r Notary nderfer, .
�o Shirley K genre•
m;ysion EE 196729
• _x pires ffy 05106!2016
•` � � ' Ex
APt�.