214 S Summerlin Ave - 08-002064 (2008) ROOF INSPECTION AFFIDAVITt
City of Sarf
BUILDING DIVISION
RE: Permit #
Inspection Affidavit
licensed as a(n) Contracto /Engineer/Architect,
please print name and circle Lic. Type) FS BUildlrig Inspector*
License #; ' C G d 2 2-4- 0 l
On or about z V D 3 0 , I did personally inspect the roo
Date & time)
eck nailin ndLor secondary water barrier work at
circle one) (Job Site Address)
Based upon that examination I have determined the installation was done according to the
H e
Mnon
Retrofit Manual (Based on 553.844 F.S.) Signs
re f
STATE:°
OFTLORIDA COUNTY
OF Sworn
to and subscribed before me this day of 200 y
Notary
ublic, State of Florida i
Linda A Keeling lre-e? , l4, e MY
Commission DD359999 a
Expires December 09,2008 (Print, type Or Stamp name) Commission
No.: a 3s Personally
known or Produced
Identification Type
of identification produced. General,
Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the deck
for each inspection.