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<br />,JURrSDICTION.~OF YOUR ,CHOICE, <br />~. BUlliD~G~EPAR'l'MENT <br /> <br />RE:Permit#~' 9/17/07 <br /> <br />'Inspection AffidaVit' <br /> <br />.I PI t/r' tlfl/;; , <br /> <br />(please print name and circle Lie. Type) <br /> <br />,licensed-as a(~= IEngineeriArchitect, <br />. Building Inspector <br /> <br />License #; lLtJ OLj t , ~ / <br />On or about J 2. J/S/(~? <br />/' (Dafe&time) <br /> <br />, I did personally inspect the roof' <br /> <br /> <br />J/ / f :2.--~:j! 5'1- <br /> <br />(Job Site Address) <br /> <br />2-- It-L[ <br /> <br />Based upon that examination I have detennined the installf!tion was done according to the <br />Hurri~ Rl:trofit Mmmal (Based on 553.844 F:S.) <br /> <br />C''' <br /> <br />Signature <br /> <br /> <br />. ~.~YOf1i, _bzUA~1'" <br />I)' I, <br />/ ' ' <br /> <br />. ' <br /> <br />.200~ <br /> <br />: Notary Public, State of Florida <br /> <br />(Print, type or stamp <br /> <br /> <br />Personally known ! or <br />Produced Identification <br />Type of identification produced. <br /> <br />Commission No.: <br /> <br />~ Gen~, Building, Residential, or Roofing Contractor ~r any individual certified under 468 F.S. to make. such an <br />lIlSpection, Include photographs of each plane of the roofwith the pcmrit # or address # clearly showri marked on the <br />deck for each inspection. . <br />