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<br />City of ZeJmyrhills <br />BUILDING DEPARTMENT <br /> <br />RE: Permit # 7 k 0 l- <br /> <br />9117/07 <br /> <br />Inspection Affidavit <br /> <br />I 5(0 it (j I~c..ktt'\~"'- <br />(please print nlaDe and circle Lie. Type) <br /> <br />,licensed as a(n~~ /Engineerl Architect, <br />8 Building Inspector* <br /> <br />License #; C c.c.. OS-, C} S-l <br /> <br />On or about tj,/ zJr /0 Is' <br />I (Date & time) <br /> <br />~ ~:!eCOndary water ~ork at. <br /> <br />Of' 'Ki) <br /> <br />Left, '1 (~lt 115 f 8 <br /> <br />, I did personally inspect the !:!l!lf <br /> <br />(,7/ 2 b~.s..J tA.J oot/ (} ~ <br />, <br />(Job Site Address) <br /> <br />Ba.."led upon tbat examination I have determined the installation was done according to the <br />Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br /> <br />sdf:!f-~~ <br />.. gnature <br /> <br />STATE OF FLORIDA <br />COUNTY OF . 1Tf-I.- <br />Sworn to and subscribed before me this ~day of <br /> <br />By &ott- o{CLclw1a.V\ <br /> <br /> <br />,.200]' <br /> <br />Notary Public, State of Florida <br /> <br />&v.~/__ <br />(print, type or stamp name) <br /> <br />Personally known X or <br />Produced Identification_ <br />Type of identification produced. <br /> <br />Commission No.: <br /> <br />.. Gem~nll, Building, Residential, or Roofing Contractor or any individual certific::d under 468 F.S. to make such an <br />inspection. Include photographs of eacb plane of me roof with the permit # or addJea.q # elearly shown mlUked on the <br />deck for each inspection. <br /> <br />