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;- � i _m Building& Code Regulation Division
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Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# !1 O(0— 04(47
I<,cki t-3 , 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 --'u (D 0a01 , I did personally inspect the roof deck nailing
(Date)
work at:
(Job site address)
Based upon that exa nAination I have determined the installation was done according to the current
edition of the Floridjd Pidsting Building Code Section 611 or the product approval submitted (whichever is
most strigent).
�C�Q�
Signat re and Seal License#
STATE OF FL RIDA
COUNTY OF \
Sworn to an subs,cJr'bed before me this da ol) �l 20
by�C1j� f 711�S��. Who to me or who has produced
aside ti ' ion.
Notary Public,State of FI ri
Signature of Notary:
Commission Number: (Seal)
En 01/19/2011
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�►%Y°•�o••. SHREISS SCHWAB
Notary Public-Stato of FloridCommission 4F FF 205427
'q � '- My Comm.Expires Mar 3.2019