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i <br /> i <br /> i <br /> r`• '` ' 04,of Zephyrh'ills <br /> ;ZegIWr4 R5 FL.3.3"542- <br /> f' <br /> -,t H S ly • <br /> RU.C?FlNG:i[USt?5CTl�N'Ai'FIDAVI--` <br /> Permit„•,o.; <br /> iicensed,under Chapter 465,Florida Statutes <br /> Conirat:tprr ,�Fcti,lfect ;13t ilding Inspector- <br /> License•No:. <br /> On orabou,t c _7..,_..__�...._ _. d.id personally,inspect..the:, <br /> - s <br /> ,7;t,,,,of n€c!i:(a.Wr.g_ Qf y,in a/ .. _'F}�53ifi�g'atin trip edge <br /> f i <br /> Check'Which Vda5 u58ttr 3Oi#felt- }'eel and St!}k_Other(ListL _ ! i. <br /> fAt tl e 16110v+tifIg <br /> Saddre?ss .. rz � ., -- rRL. �G�,%»':�.ev `''-''�'� - -�' =—' ___•a <br /> Ba�eii:ufpbn_that exai-6ih4t"i0.h; l haveActermined the,insfallation,Was;ddne a'Cc rd'n- the:Hiurricaiie, <br /> milWati6h.Retrbfit Nlarival,(Based on.Secilon 553:844,.€"lorida Statutes): <br /> t. y <br /> W Notary,�Nbtic SUM.tSE.M ida <br /> :Jutie'Rene`.Flaak <br /> � My,CbmmissionGG:?tJ57Z2 <br /> �t1}UT'f< }� 5C0- vwo ,? Eipires04122=2!2 <br /> Swum.ty; iid= iI}ascr'i k� coi;e L it day <br /> By. <br /> flat ly P blic State. f Florida <br />