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<br />p le,,~ <br /> <br />S<.., f- up {e..,. Pr'Yl~ I Tn .$/"("( 116'" <br /> <br />JURISDICTION OF YOUR CHOICE <br />BUILDING DEPARTMENT <br /> <br />HE: Permit # 2'l..lJK..___ <br /> <br />'1117107 <br /> <br />Inspection Affidavit <br /> <br />I .2~.Rl,It-.J)L4..~k 1"1.4 t" <br /> <br />IT"e=J~(~ )'Win. "lime and circle Lie. Type) <br /> <br />,_ ,licensed as a(n) Contrllctor"/Engineer/Architect, <br />FS 468 Building Inspector" <br /> <br />Lice"St~ #; {'CLO~7 C, 5 1 <br /> <br />On or ahout.. h/ /3/, t?Y <br />(1)"le &. lime) <br /> <br />C;;;:;:;;li.ml..1Ln~r se~()ndarv waleI' barr.!~work at ,3g.J~.lic.~n( L/..p,(, <br />t CfC' rm. (Job Sile AdcJres.~) ;1- <br />2 eph1-[h, / (( ,-fL--. 'u__....,________,__.. _.. __., .._.. <br /> <br />Based upon that examination I have determined the installation was done according to the <br />)Iurricant.' Mitigation Retrofit Manual (Based On 553,844 F.S.) <br /> <br />, I did personally inspect the ~!1[ <br /> <br />~~- <br />Si,~"Atllrc <br /> <br />STATE OF FLOR.IDA <br />C()lINTY OF <br />",worn to a~d subscribed berore me thisL3._day of .Jld1L_,_...__. 2003 <br /> <br />li:-- 0~~tF (0(Q.c.k ~"_' <br />N~li~' State of Florid~ , <br /> <br />Pr ~-.."k~ <br />( int, type or stamp name) - -./-- <br /> <br />Personally knownL or <br />Produced IdentifieatiOtl <br />IYPe- ofidentil1cation produced"_n <br /> <br />Commission No,: <br /> <br />-..---- ----'.--.--. <br /> <br />~. (;cnc!"'JI, Kuildinl:l. fC.esid.enbll, or RCX1fing Conltactor c~r ~y indiVidual ccnitied under 46R F.S. (I,) rnk~e ,udl all <br />ln~"e~llon. In~lude fJ~lo8mph., o(eacb p~nc nfLhc: mo1 wnh Ute permit II ur addr'eh ~ clearly 5hcM'n mlJlkcd olllhe <br />:It'('k for each ,"~Cllon. <br /> <br />.~- COIII_ KEOlJOH <br />'" "*Y PulIIc . s.. III FIadiII <br />-. . c-.lIIIonEJ,noAllg 17.21110 <br />· . CenInIIIolon , 110 _ <br />· ........ Iy "- NIllIIy __. <br />