703 Sarita St - BR08-002660 - Inspection AffidavitRE: Permit # 0 Z 6 ( 6
Inspection Affidavit
kr IGOG`( -% ,licensed as a(n) Contractor* /Engineer/Architect,
please print name and circle Lic. Type) FS 468 Building In
License #;CC(e2 7=01
On or about , I did personally inspect the roo
Date & time) (
r
deck nailing and/or secondary water barrier work at
circle one) (Job Site Address)
tea ti &11 )5 li 7 7 / _
Based upon that examination I have determined the installation was done according.to the
Hurr' e Mti on Retrofit Manual (Based on 553.844 F.S.)
Signat e
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this day of • 200V
By
f
f+Ay Gor nnssiC D3}6gfs8
Personally known /or
Produced Identification
Type of identification produced.
Notary Public, State of Flonda
Print, type or stamp name)
Commission No__
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.