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<br />.JURlSDICTION, (OF' YOUR ,CHOICE', <br />. :'BUIDD~G'l1)EPARDmNT <br />RE: 'Pennit4f.173 g-3 <br /> <br />9/17/07 <br /> <br />'In,sPection AffidaVit' <br /> <br />J 0D# ~ t:kJIII<< JL <br />r <br />. (please print DlIIDC and cbd.e Lie. Type) <br /> <br />~asa(~=~ <br />, . ' ~ 8 "Ud'fT1g lnsp~etor* <br /> <br />License#; tee (:);79 ~7 <br /> <br />On or"about 1/1'1 /Pd" .3 : ~tJ ,;P,A1' . I did perso~y iDspectthe roof <br />(Date cfe time) . <br />Gcknailin("'l,d/s:.~~~at 6'l-1r 5/".....,. d.../u .or <br />_ {l~ _I " .' (Job Site Address)' <br />z-t'f~vhi~/J Fa , . <br /> <br />Based upon that ~lIt1'ImRtion I haYe detemrined the insta1lation was done according to the <br />Hurricane Mitigation ~ofit Manusl (B~d on 553.844 F.S.) <br /> <br />~~ ' <br />Signature . <br /> <br />STATE OF FLORIDA <br />COUNTY OF <br />Swam to and snbscn"bed before me 'this ildaY of ~Q...0... . <br /> <br />By <br /> <br />.2008. <br /> <br /> <br />Notary pUblic, State of Florida <br /> <br />~~~~~ <br /> <br />CommissionNo.:1)\) Sew~ <br /> <br />Personally known /" or <br />Produced Idmtification <br />Type of identification prod11f~ed. <br /> <br />~ Galeral, :Bulldiq, lleaidea1isl,. or lloobg CmdracIDr Or auy iDdMdoa1 ~ 1IIIder 468 :t:'.s. 11> ~ su.cb an <br />iDlpcction. lDcJ.udc phOtOgraphs of elICh p~ oftbe. JtXIfwilb. tbc pamit #- or addn:as '# claQy IIbDwJi DUIrited Oil. the <br /> <br /> <br />-...--- . ~yt1~ ~ <br />. CORI_..... . <br />....,..... ~..... <br />. ~ .. a4t AllIn. <br />f .. .IID_ <br />....... __ Ala <br /> <br />