HomeMy WebLinkAbout2404 Adams CtCITY OF SANFORD BUILDING SERVICES,
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #:
I, 7;c-4 jAallou hereby acknowledge that I personally inspected
WIFAv400fdecknailingand/or i'Secondary water barrier work
at -- .(' 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
understand that malting any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section F.S. /
6
Sia ure ontractor Date
Printed Name of Contractor License #
License Type: General L, Building Residential Roofing Contractor
1-1 or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF C _
Sw o,.ta aff'r ed) ind subscribed before me this day of O , 20 , by
who is%.. Personally Known to me o as Produceifl ype of
id ntificati n) as identification.
SEAL)
Si ature olootary Public
tate of Florida
Print/Type/Stamp Name
of Notary Public
LINDSAY DUCKHAM
Commission # FF 172210
oc My Commission Expires
October 28, 2018