HomeMy WebLinkAbout100 Hazel BlvdFROM :JOHN WORCESTER FAX NO. :4078121748 Oct. 25 2006 12:18PM P1
REGARDING ROOF DRY -IN AND FLASKINGS
INSPECTIONS.
AFFIDAVIT'
COMPANY: 1'tA L ROoF1N4 LICENSE NO: CC L QZ5702-
PROJECT INFORM ION
j `
SUBDIVISION. L G I X P4 ADDRESS: 0 14AZEL 1.i LVJ1
ea
PERMIT NO: _ Q7 ' ) 2— LOT: _
1,
11-
14
N WOKUSIER. affiant. hereby affirm that I am the duly licensed contractor of record for the above refumuce
permit, that all of the foregoing infomnation is true and &vcurate, and that the dry -in, (lashings at the above referenced address4ot has
been installed in accordance with all applicable codes and standards.
CONTRACTOI
STATE OF FLORIDA
COUNTY OF ORM4C
This t' trument s aclwowled gged before me this 73 day of 11 , by the above rofmoced
individual, 7 oNN z of t 5'F4 , who Acknowledged that h%Cis a duly liecnscd contractor with
rhMA , and who aeknt wledBed that hat wau suthoriud to cxecule this document. HcAaWis
eithta personally (mown to mu or produced C4` Igo W `ZZ '1' I Z 6` aLs O as valid ideatificativn.
WITNESS my hand and official seal this 2—C!d—ey of
Printed Name:(,,,
My Commission
Garry oldh 5taltt01Florida
t3anr Cobterb
r.v .:wrnisslon D05%529
w V eAPVes 021120ID