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<br />City of ZeIDLvrhills <br />B~DING DEPARTMENT <br /> <br />RE: Pennit# 71 y L <br /> <br />9/17/07 <br /> <br />Inspection Affidavit <br /> <br />5Chtt 13l~<-kMA.V\ <br /> <br />(please print name end cin:le Lie. Type) <br /> <br />,liceused as ~~Dgineer/Architect, <br />68 Building Inspector'" <br /> <br />License #; LeL o~ 7 C) 5'"1 <br />On or about '-I / ~ "L I tJ 6' Z -' Of) P pi( <br />. (Date & time) <br /> <br />, I did personally inspect the roQ[ <br /> <br /> <br />water barrier <br /> <br />orkat bS~l Fo~ ty,60, {)v <br />(Job Site Addn:ss) <br /> <br />. ~~ \~~ \., " l\.s F I 3 3~t./L <br />Based upon that examination I have detemrined the installation was done according to the <br />Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br />~~,~--- <br /> <br />* . <br />Signature <br /> <br />STATE OF FLORIDA <br />COUNTY OF _lJ B ,) <br />Swo~..,to and subscribed before me this ~ 'lfay of - r n <br /> <br />Bv ~ 0 tt B kL.c1 VV\Q v\. <br />__ <br />Notary Public, State of Florida <br /> <br />r:f7V.~. ~"-- <br />(print, type or stamp name) <br /> <br />. 200_~ <br /> <br />Personally known ~r <br />Produced IdentificatioD,--- <br />Type of identification produced. <br /> <br />Commission No.: <br /> <br />.. Omenl. Building. Residential, or Roofing ContnlC:toT or any individual certified under468 F.S. to make such liD <br />il1spcc:tion_ Include photogl'llphs of each plane '"the roof with the pc:nnit #. or address ~ cleerly shown marked on the <br />deck foT each inspection. <br /> <br />. cat. Ml41CEDUGH <br />~ ,... . .. ~,...... <br />. . Col..... ''''Allt17.2II'O <br />CIm . IJ ,'DD_ <br />............. .... <br /> <br />