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Building&Code Regulation Division
2300 Virginia Avenue
e Fort Pierce, FL 34982
-..,, 772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# r / 6` 717
6I, "1- licensed as a(n)Contractor*/Engineer/Architect
(Please print nike&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 �c �U�6 , I did personally inspect the roof deck nailing"
(Date) �I
work at: 6 ��/ 1� ZG
(Job site addr )
Based upon that examination I have determined the installation was done according to the current
edition of th Existing Building Code Section 611 or the product approval submitted (whichever is
most str'
I ature and Seal License#�
STATE OF FLORIDA
COUNTY OF
Sworn to and subcribed before me this- day of N�V 201_,0
by'P�m `X ona y no o me or who has produced
as identification.
Notary Public,Stao FI i a
Signature of Nota
Commission Number: (Seal)
ittz
En 01/19/2011LASHAHN RAM
#° Notary public_StaNe of Florida
iN!
°;', MYComm-Expires Dec 20,2018
:F
L-0`?% Commission#FF 177P49
Bonded through National Notary Assn.
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