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" ••• Building&Code Regulation Division
51111111111 �601111111 2300 Virginia Avenue
Fort Pierce, FL 34982
---=-- - .,= 772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# 16901"
,�"4Y�D , licensed as a( Contractor* Engineer/Architect
(Please print&circle license type) *FS i Ing Inspector
*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to make suer an Inspection.
On or about — .j I did personally inspect the roof deck nall!n
(� l
D�/ate)
work at: �7 �&,"
(job site address)
Based upon that examination I have determined the installation was done according to the Hurricane
Mitigation Retrofit Manual (Based on 553.844 F.S.)
SI n ture ani eal License#
FEB 10'2016
STATE OF FLORI A
COUNTY OF .
5wor to and subscribed before me this day of �%� `� 20
by . Who is personal) Known to me or o has produced
as identification.
Notary Public,state of Florida
Signature of Notary:
Commission Number= (Seal)
En 01/19/2011 ,,
°" `?� DAVID VANDGRISLIgR
;kr)' MY COMMISSION#FF098550
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