HomeMy WebLinkAbout5000 Island Bay CirCITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: I - L I
d -I . I, ' ` ahereby acknowledge that I personally inspectedp
oof deck nailing and/or econdary water barrier work
at 00 v WOO 640fCl fOV) l 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 nd that making any false statements in writing with the intent to mislead a public servant in the
pear m nce of his or her offici duty shall constitute a misdemeanor of the second degree, pursuant to
Sect' n 6 F.S
U
d J
Signa of Con actor Date //'
rq6iCcc 131405'
Printed Na'me`ot Contractor License #
License Type: El General 11 Building El Residential t Roofing Contractor
or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF l'I if / Y "t `(l -h
Sw to (r ffir ed) and scribed before me this day of 20 D_, by
who is 34k- pally Known to me or has roduced (type of
ide as identification.
SEAL)
Sign ture o Publ'
Print/Type/Stamp Name WALTER FLORES
of Notary Public Notary Public- State of Florida
Commission # EE 866557Vm Commission Expires Jan. 21, 2017