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CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
hereby acknowledge that I personally inspected
D-R:6`ofdeck nailing and/odary water barrier work
at o Ll%rG-- r Va- L/ Ar`i/, a7 7
Job Site Address)%Z and have determined that the work
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 fullyunderstandthatmakinganyfalsestatementsinwritingwiththeintenttomisleadapublicservantintheperformanceofhisorherofficialdutyshallconstituteamisdemeanoroftheseconddegreepursuanttoSection837.06 F.S.
Sign r o o ractor
Date
ranted Name of PCContractor - G_ZLicense #
C.
License Type: General Building Residential Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF '_. t,`p C*1Swornto (or affirmed) and subscribed before qe tthjs day of m 8 9 C V{ 20 ,
who is Vrsonally Known to me or has Produced
by
inaature as identification. (type of
SEAL)
of Notary blic
St to of Florida
4_ Notary Public State of FloridaPrint/Type/Stamp Name h Linda w Pi9oZZi
of Notary Public 0,M1Oe My ces8/07/2017
043599'
3