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Code Compliance Division
2300 Virginia Avenue
LORI • Fort Pierce, FL 34982
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772-462-2172 Fax: 772-462-6443
INSPECTION AFFIDAVIT
Re: Permit#
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Engineer/Architect
(Please print name&circle license type) pector
*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about_9— (( ((o , 1 did personally inspect the roof deck nailing and/or
(Date) (circle those that apply)
secondary water barrier work at: .:3S-314 tom- 't=—i ac-7Z 7 r=-i_ 3 LigL6-
(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.)
Signature and Seal License#
STATE OF FLORIDA
COUNTY OF !Sar-%-'-.)C'%
Sworn to and subscribed before me this day of Q C 20_k G
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L —T as identification.
Notary Public,Statelorida
Signature of Notary..
Commission Number: Seal) D ANNA G1VE�o Florida
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En 09/17/09 :o` . = Comm.EXP EE a58761
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