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<br />JURISDICTION OF YOUR CHOICE <br />BUILDING DEPARTMENT <br /> <br />RE: Permit # ~O 0 I <br /> <br />9/17107 <br /> <br />Inspection Affidavit <br /> <br />I SuifeAQL~C1.h <br /> <br />(Please print nllllle and circle Lie. Type) <br /> <br />,licensed as a(n) Contractor. !Engineer/Architect, <br />FS 468 Building Inspecto~ <br /> <br />License #;CCl.. OS-I 'i S-1 <br /> <br />On or about {O/ ~ 110 g , I did personally inspect the roof <br />(fi.te &. time) <br />r;;;;:;;-~ ~~..~;;d",y wale, bani';J- at 3<1507 ('It ~""'ood4.. <br />~ (gr... .! ~ -- - (Job Site Address) <br />Z.e..ph~""hd j,S / F \ <br /> <br />Based upon that examination] have detennined 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 11-1~ <br />Sworn to and subscribed before me thi~day of <br />By cScd:t- t>~~ J\. <br /> <br />c'v....,ne <br /> <br />.2002 <br /> <br />Notary Public, State ofFIOJ:ida <br /> <br />~.~~ <br />. t, type or stamp name) <br /> <br />Personally known ~ or <br />Produced Identification_ <br />Type of identification produced, <br /> <br />Commission No.: <br /> <br />.. General, Building, Residential, or RoofiDg Contractor or any individual certified UDder 468 F.S. to lMke such an <br />inepection. Include pbotognlphs of each plllUe of the roofwidl the pennit'## Of address '## clClll'ly shown marked on the <br />declc: for each inspection. <br /> <br />. CORI ANN ICIOUGH <br />...., NlIII: . .... " ..... <br />. . Ctl" "'_11',_ <br />t .. .'00_ <br />............. ... <br />