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<br />7 '-v'- (.)0 '7-1 <br /> <br />City of Zephyrhills <br />BUILDING DEPARTMENT <br /> <br />RE: Permit # 7 '" /5 9/17/07 <br /> <br />Inspection Affidavit <br /> <br />I S c{) It A /4. rl M~ h <br />(please print name Iftd ciJcle Lic. Type:) <br /> <br />,licensed as a(n)~tracto~ngineerl Architect, <br />4b~ uiIding Inspector* <br /> <br /> <br />License #. (( CbS- ") ~ ~ 1 <br />, <br /> <br /> <br />On or about 3/111 D ~ 2: 0 t.i f M , I did personally inspect the roof <br />. ,<Date & time:) <br /> <br />and/or seconda water barrier ork at 3 9 "2 I " {/111 J1v~ <br />(Job Site Address) <br />'2e.f~{~,"/Jj F/ "3)C)t!L.- <br /> <br />Based upon that examination I have determined the installation was done according to the <br />Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br /> <br />~,/~ .~ <br />Signature <br /> <br />-- <br /> <br />STATE OF FLORIDA <br />COUNTY OF t -DJ .h <br />Sworn to and subscribed before me this ~~y of tl Y'( <br />'\ ' . <br /> <br />.200~ <br /> <br />By <br /> <br />~-~~. <br /> <br /> <br />n;:nc, Sta~fF1 . <br /> <br />(print, type or stamp name) <br /> <br /> <br />Personally known ~ <br />Produced Identification_ <br />Type of identification produced_ <br /> <br />Commission No.: <br /> <br />.. General, Building, Residential, or RoofiDg ConlX1lctor or any individual certified under 468 F.B. to make such an <br />inspection. Include photographs of each plane of the roof with the permit #- or address # clearly shown marked on the <br />deck for each inspection. <br /> <br />