HomeMy WebLinkAboutRoof Inspection Affidavit ,r Planning&Devel6pment Services
Building&Code Regulation Division
23W Virginia Avenue
Fort Pierce FL 340 2
772-462-2165 or 772-462-2172
Fax. 772-462- 3
MF iN5PEC'1O-N MFIRAVI ,
Re: Permit#� ( i
!, I I„1 ic.6b 7— U�S,dur , 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 ceaifled under 468 F.5.to make such an inspection.
On or about I did personally inspect the roof deck n )line
t(Date)
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition 'da Existing Building Code Section 611 or the product approval submitted (whichever is
mos Agent).
Signa ure and Seal License##
sTA`rE or FLO
COUNTY QF
Sworn to and sub albed b fare me this�� day of Juno 20
by 'tAlha is personal] knot to me or who has produced
as identification.
r �-
Notary Public,State of Florida
Signature of Notary:
Commission Number: (Seal)
En 01/19/2011
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