HomeMy WebLinkAboutInspection Docs To: 17724621578 From: 17724928008 Date: 10/12/15 Time: 8:17 AM Page: 02/02
Planning& Development Services
Building& Code Regulation Division
2300 Virginia Avenue
o a Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#5LC,-— S 1 '00'LA
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 10 � ) 1 �5 I did personally inspect the roof deck nailing
(Dale)
work at: 5 0� � Jtrn �
0
(Job site address)
Based upon that examination l have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most strigenj t).
Signature and Seal License#
STATE OF FLORI� 1
COUNTY C. S C,�
Sworn to ,nd sub ribed before a this d k��20�
ry Z� -�c,�G c,�C� . Why ersonall known o me or who has produced
ti° as identification.
Notary Public,State of Florida
Signature of Notary:
Commission Number: (Seal)
En 01/19/2011 ??p; ,. ADAM L RYCKMAN RECEIVED
MY COMMISSION#FF145513
'! d°= EXPIRES July 27,2018
,,, . ... OCT 12 2015
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