HomeMy WebLinkAbout6000 Island Bay CirCITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: I ( - C I (o
I
f-yfhC. hereby acknowledge that I personally inspected
o -of deck nailing and/or econdary water barrier work
at W 3 //,A j % folfULICl % 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 her in are true and accurate to the best of my belief and that I fully
underst d that making any
her
st ements in writing with the intent to mislead a public servant in the
perfo ma a of his or her officia d ty shall constitute a misdemeanor of the second degree pursuant to
Sect n 83 6 F.
03 U
Sign lure on actor Date
PMO V IC h CCC 3140
Printed Name of Contractor License #
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
Sw to (r ffir ed) ands scribed before me this day of*,
a4,
20 of byS7/ , who is C nal y Known to me or 1]has roduced (type of
i ification) as identification.
SEAL)
S gnatur otary ublic
Print/Type/Stamp Name
of Notary Public WALTER FLORE
Notary public- State of FloridaCommission # EE 8f,6557W -Commission Expires Jan 21, 2017
3