HomeMy WebLinkAboutRoof Inspection Affidavit Planning& Development Services
Building& Code Regulation Division
2300 Virginia Avenue
a Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit#
licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building Inspector
*General,Building,Resident-111 or Roofing Contractor•r any individual certified under 468 F.S.to make such an inspection.
On or about /0 -a 10 ' , 1 did personally inspect the roof deck nailing
(Date)
work at: �1� ,. S. � C:
(Job site address)
Based upon that exaam.nat'o�ave ete mine installation was done according to the current
edition of the F c�riaa Existing Building de 1i n411 or the product approval submitted (whichever is
most strig
/1`5-11g:;z-u e a S ;f License#
STATE OF FL RI n��w,
COUNTY OF HH11�L. S
Swppor(�'to and sub ribed be`forg me this 20JU
by1 ogirl A UM wh • ersonally known tri has produced
as i ion.
Notary Public
SignatuF
Commission Number: (Seal)
En 01/19/2011 °+!d_ BRAA9CPl EU9URCHBa®f49
r,.
z; MY COMMISSION#EE863426
EXPIRES January 08,2017
X0071398-0153 FlorldallotaryServica com