HomeMy WebLinkAbout134 Kelly Cir0712312015 12:32 city of sanfora - Iju
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CITY OF SANFOR:D BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigatioii Inspection Affidavit
Permit #:
r
hereby acknowledge that I personally inspected
Roof deck nailing and/or* Secondary water barrier work
at /3 44 e e-.5
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and have determined that the work
Job Site Addre s)
was done according to the Hurricane Mitigation Uetrofit Manual. (based on 553.844 F.S.)
I certify that my statements herein are true and accurate to, the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section 837.06 F.S.
Signature of Contractor Date
11::3Q
Printed Name of Contractor License #
License Type: 0 General Building Residential KRoong Contractor
or, any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF
orn to (or aIrmed) and subscribed before me this day of , 20 l , by
who islOersonally Known to me or h s Produced (type of
id t catn as identification. g- (
SEAL) of
NotaN Public of
Print/
Type/Stamp N of
Notary Public NEW
S. ESPINOSA a01;
n
1B`
Notary Public -State of Florida My
Comm. Expires Jun 2, 2016 Commission #
EE 203953 OF
fNol" Bonded Through National Notary Assn.