HomeMy WebLinkAbout11000 Island Bay Cir1\
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: I tc - (OD-1
1, ct,C 9--e-- .—o .off hereby acknowledge that I personally inspected
Roof deck nailing and/orA Secondary water barrier work
at I I Wo .['t c r-1 [ , r 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
under d that making any false statements in writing with the intent to mislead a public servant in the
p' ma of his or her official d shall constitute a misdemeanor of the second degree pursuant to
Secti(n 83
1 Signature of Contractor Date
ctt. 3 So 4 0S
Printed Name of Contractor License #
License Type: General Building Residential 11A6ofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF C)—c,n e
Sworn t
Taffir e, and ubscribe before me thi day of M G , 20 6 , by
i 14v,1 V"W, who is rsonally Known to me or has El Produced (type of
id ification) as identification.
SEAL)
nature of Notary Public
tate of Florida
Print/Type/Stamp Name Kbaft Mores' of Notary Public WTARY I
STATE OF FLORIDA
W24=19
C