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- Building&Code Regulation Division
N 2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax:772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#
f, JZ GU" licensed as a n)Contractor /Engineer/Architect
(Please pri name&circle license type) xF' fib Build' g"Inspector
*General,Rutlding,Resldentlal orRoofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about I did personally inspect the roof deck nailing
(Date)C />> f
work at: �•� a5 a/>-5 b�
(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.)
Sign ture an eal License#
STATE OF FLORIDA
COUNTY OF- /�
Sworn tfj and subsc i✓ed before me this day of ZWY 20_/lQ
by ((.' ' l(dr who is personally known to me or who has produced
as identification.
Notary Public,Stale of Florida
Signature of Notary:
Commission Number: (
Sea{)
En 01/19/ 011 DAVID VAFfDERFLIER
My COMMISSION#5Fae9560
EX IRR=S March 9,20113 q 1 016
(407)3913.0153 Fkiridallotn 99ry1ce.aofn
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