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0612912016 08:41 ONSHORE ROOFING SPECIALIST (FAX) P.001 tool
Planning& Development Services
Building&Code Regulation Division
A
AD— 2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# 05OR
I Engineer/Architect
1, 1 6Sebk licensed as akgii�
I
(Please print name&circle license type) *F5468 Building Inspector
*General,Building,Residential or Roofing Contractor or any individual certifled under 468 F.S.to make such an inspection.
On or about Q'Wo , I did personally inspect the roof deck nailing
VDate}
work at: I OTS I CCLWJ scl
(job site address)
Base on tha examination I have determined the installation was done according to the current
ed* ion of the FI rida Exist' g Buildin de Section 611 or the product approval submitted (whichever is
ost strigent).
Ccc. Is a ' 9 LI
Signature and Seat License#
STATE OF FLqR DA
COUNTY( 6�f+tp"l
Sworn to nd sahscAed befgre,me this day of.,
'J - J( 20A
b rt:511r?6 /e�,4 –. Who is personally known to me or who has produced
as identification.
Notary Public,State Of ria ti
Signature of Notary—,
Commission Number: (Seal)
En 01/19/2011
SCHWAB SHREISS SCHWAB
71 S Notary Public-State of FW1011411
Commission#FF 205427
!t
s Mar 019
My Comm.Expires Mar 3,2019