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Building& Code Regulation Division
i - 7
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# L22
I, 'JC,nv,.rJ licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about_ �O- l - ll� . I did personally inspect the roof deck nailing;
(Date)
work at: 3k ka S. C- s-E .
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most strigent).
LA--j V` l',Cl i cc-
Signature
CSignature and Seal License#
STATE OF FLORIDA
COUNTY OF S+ L k C e-
t� �
Sworn to and subscribed before me this day of OCfo IK0 Pr 20
by R, c� Who is Emsonally known tQ or who has produced
as identification.
Notary Public,State of Florid
Signature of Notary:
Commission Number: F T=a 38 333 (Seal)
En 01/19/2011
CASEY BINKLEY
?MeMy COMMISSION#FF238333
EXPIRES August 16P. 010