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<br />City of ZeWrhills <br />BUILDING DEPARTMENT <br /> <br />RE: Permit # 7fJ,'fo <br /> <br />9/17107 <br /> <br />Inspection Affidavit <br /> <br />1 Stll~~h <br />(pICII$c print name and citcle Lie, Type) <br /> <br />;licensed as a~=~gineer/Architect, <br />: ; udding lnspector* <br /> <br />License #; C. CLOS-7 '7 S-1 <br /> <br />On or about ~/ 2-1 / (j ~ L ';',0' 0 PM. , J did personally inspect the roof <br />r (Date & time) <br /> <br />4.-ek naili"" and/or secondarv water barrier *ox:k at J .tct'3 L l-/e/'\.r'J b' <br />tf.<n;ee' Qne,J ./' (Job Site Address) <br />'_~\"'t~'I..\rll ~ ~ I ~3s1 ( <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 />STATE OF FLORIDA <br />COUNTY OF I- m <br />Sworn to and subscribed before me this B..l'S day of a..rch. <br />By (3 en if ~ \ a..u.. MG\. V\ <br /> <br />_200? <br /> <br />Notary Public, State of Florida <br /> <br />~.~~ <br />(Print, type or stamp name) <br /> <br />Personally known ~r <br />Produced Identification_ <br />Type of identification produced. <br /> <br />Commission No.: <br /> <br />.. General, Building, Residential, or Roofing Contractor or any individual certified undcr.468 F .5. to make such lIll <br />inspection. Include pborogt1lphs of alCh pJllne Df the roof with the pcnnit #. or addn:as #. clearly sbown marked on the <br />deck for mch inspection. <br /> <br />-= CORl MN KEOUGH <br />,.." PuIlIa . StIlt III FbIdI <br />. . CollI' Y ElpMA/.W 17, 201 <br />CGlMA.A.' . DO 11II03 <br />...... ., ........, ~, <br />