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Building&Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
17 Re:Permit# ` y D G6 p-7
licensed as a(n)Contractor*/Engineer/Architect
(Please pr'n name&ci I cense 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 abou � �`" , 1 did personally inspect the roof deck nailing,
(Date) _
work at:
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the FI a Existing Building Code Section 611 or the product approval submitted(whichever is
m st strigent).
7100
ature and(seal License#
STATE OF FLORIDA
COU NTY OF `
Sworn to and subscribed before me this v day o 20L�O'
by Gam}2, U PC Who is perso ly known o me or who has produced
%,—/ as identification.
Notary Public,State of Florida
Signature of Notary:
Commission Number: U (Seal)
En 01/19/2011
4PH�°Y''• AUDi?EY B.HUMPHREY
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MY COMMISSIGIv#FF 174772
EXPIRES:March 6,2019
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