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� �� Building&Code Regulation Division
23010 Virginia Avenue
Fart Pierce, FL 34982
=�x 772-462-2165 or 772-462-2172
I Fax:772-462-6443
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ROOF INSPECTION AFFIDAVIT
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Re; Permit#_ ✓ —`�-°t3,
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licensed as a Cantracto Engineer/Architect
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(Please print name&circle.license type) *FS46S Bui rnge l.nspector
*General,Building,Resid ntial or Roofing 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)
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work at: � 7 Iii _ tlt_
(Job site address)
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Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 612 or the product approval submitted (whichever is
most strigent).
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Signature a d Sear License#
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STATE OF FLORIDA i -
COUNTY OF 'A L" C/
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SWOR to and subscrlbed before me this - day of i 2Qi,
by pi le oLlief—, Who is personally known tome or who has produced
i as identification.
0•`. RENEE S. MAL.LE
Notary Public,State of Florida t"f% COMMISSION#FF127485
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Signature of Notary: 11 , � .-VEXPIRES AUG.27,2018
Commission Number: I FF i a,-7 4qs (Seal) 8MEDT ROtMPUSURE1YC0'
En 01/1912011
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