2478 Sanford Ave - BR09-000172 - INSPECTION AFFIDAVITRE: Permit # 69 01
City % of,Sanford
BUILDING D.N
Inspection Affidavit
CQM 1 /2 ,licensed as a(n) Contractor* /Engineer/Architect,
please print name and circle Lic. Type) FS 468 Building Inspector*
License #; C 3 2 U 9 V
On or about 10--17--0 S' YVI , I did personally inspect the roo
Date & time)
deck naili nd/or seconda water barrier work at AV 7
circle one) (Job Site Address)
Based upon that examination I have determined the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
1
Signature
STATE OF FLORIDA
COUNTY OF ^ pSworntoandsubscribedbeforemethis, M day of 0 C . 200_s
By Gt
Notary Public, State of Florida
PAnt, type or stamp name)
Commission No.:
Personally known VI - or
Produced Identification
Type of identification produced._
MY COMMISSION # DD6L9uy1)
EXpIRFS: February 25,'2011.
y f I. Notary Discount Assoc Co.
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.