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Re: Permit tf
1, C.,hclAi .S 2 Cj 1;r6(S , licensed as n) ontrac r*/Engineer/Architect
(Please print name & circle license type) *FS4S8*Buiiding inspector
(FAX)7724646600
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
P.0011002
*General, Building, Residential or Roofing Contractor or any Individual certified under468 FS. to make such an inspection.
On or about
, 1 did personally inspect the roof deck nailing
(Date)
Work at: '1 obF, h-e10,nr - Pio n (a o,
(Job site address)
Based upon that examination 1 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
t lent).
mos
CCC. )326/1-7
Signature end Seal License #
STAT; OF FLORIDA
COUNTY OF n.LC.t_a.
Sworn to and subscribed before me
by
this LS day o C'0 20113
Whois,personally known to me or who has produced
as identification.
NotaryPublic, State of FloridaSignature ofNotary: <G�
Commission
Number:
En 01/19/2011
(Seal)
FAITH MASON '
* MY COMMISSION # GG 003998
E(P[RES: dune 20, 2020
BondedThNBudget NotarySe ;vel