HomeMy WebLinkAboutRoof Inspection Affidavit Planning& Development Services
., Building&Code Regulation Division
2300 Virginia Avenue
Fart Pierce,FL 34982
............... i..:.,. 772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#
licensed aa(n)Contractor* I gineer/Architect
(Please print arae&circle license type) * ► ing Inspector
*6enerai,Building,Residpntial or Roofing Contractor or any Individual certified under 468 F.S.to make such an Inspection.
On or aboutl� , I did personally inspect the roof deck nailing
(Date)
work at:
(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.)
Sin tore anti' eat License#
STATE OF FLORIDA
COUNTY OF JT-L.c/P e,.
sworP640 and subscribed before me this day of 20
by - – 1, 11 4� —, who is personail lnawnIte or who has produced
as identification.
Notary Public,State;ofFloridaSignature of Notary:
Commission Numbe (Seal)
En 01/19/2011
�`•"•:` DAVID VANCE14FLIER
MY COMMISSION*FF099560
'•;ra EXPIRES Mwoh 9,2018
II (QR 398.W53 F10tiCIRNdIR SRM04.04A7
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