HomeMy WebLinkAbout215 Brushcreek Dr (2)CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: S-- -2 g q
I, Ml // hereby acknowledge that I personally inspected
Roof deck riling and/or Secondary water barrier work
at -Cy S lCCv?_ and have determined that the work Job
Site Address) was
done according to the Hurricane Mitigation Retrofit 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 perform
ce of his or her official duty shall constitute a misdemeanor of the second degree pursuant to Sectio
7,.06 F.S.4 z) Signature
ffd'ntractor Av
y ,I&C Printed
Name of Contractor 1-
7-1 Date
ccC-
IS License #
License
Type: General Building Residential d Roofing Contractor 0
or any individual certified in accordance with F.S. 468 to make such an inspection. STATE
OF FLORIDA COUNTY OF Sworn
to or affirmed and subscribed before me thhs--_ day of , 20, by elv2 ,
40/1 y o-Ot--- , who is WPersonally Known to me o as Produced (type of identificatioig4
as identification. v
Y (SEAL) Signature
of &otary Public o ot+YE 12i2es' Staj,
e of Florida / +`V.I MEXpjRES j°N„tyzPU
en Print/
Type/Stamp Name of
Notary Public 3