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CITY ,OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
I, hereby acknowledge that I personally inspected
Z Roof deck nailing and/or M Secondary water barrier work
at %'_ p W 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 i his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Sectiox'$3 .. S.
Printed Name of Contra r
Date
C 0s s 8
License #
License Type: General Building Residential ERoofing Contractor
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 this Z day of 20 )S , by
who is Personally Known to me or ha's Produced (type of
identi do as identification.
SEAL)
Signatu e f otary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
W,
n4PAr PV, DAVID CDNNELL
Notary Public - State of Florida
My Comm. Expires Aug .2,2016
F FFCommission # EE 27ItIN-