HomeMy WebLinkAbout12000 Island Bay CirCITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: I ( ', CL Z
Roof deck nailing and/or rWat— LOUD l J hereby
acknowledge that I personally inspected water
barrier work 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 accutate to the best of my belief and that I fully understan
that making any false st ents in writing with the intent to mislead a public servant in the perform
nc of his or her official d ty alconstitute a misdemeanojofth second egree pursuant to Section
837 F.S. 2-
j Signa
ontract r Date 32
n PAL,,W, n''de'i-. -- - Ca. 0 Lb__J- Printed
Name of Contractor License # License
Type: General Building Residential Q oofing Contractor or
any individual certified'in accordance with F.S. 468 to make such an inspection. STATE
OF FLORIDA COUNTY OF V I— S
n o ( r irme tsubscrip_ed before me this day of r v ` u VC b , 20 / O, by ax whois3-rer or has Produced (type of de io'
as i entification. SEAL) lure
of
No a Public 0State of Flor' a Print/Type/
Stamp Name of Notary
Public WALTER FLORES
Notary Public-
State of Florida Commission # EE
866557 My Commission
Expires Jan. 21, 2017 3