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<br />City ~of Zephyrhills <br />BUILDING DEPARlfMENT <br /> <br />RE; p'ennit'# 80b7' 9/17/07 <br /> <br />Inspection Affidavit <br /> <br />"'- , <br /> <br />I -..k~ V~" ~,~~ <br />. <br />(please print name and circle Lie. Type) <br /> <br />,licensed as a(n) Contractor* !Engineerl Architect, <br />FS 468 Bll~lr1jng Inspector* <br /> <br />\ <br />\ <br /> <br />License #; e.c:..c.. ~ ~ <br /> <br />On or about 7/' t.i/c:9 ' : 30 ~ , I did personally insp~ the roof <br />~ (Date: " time) <br /> <br />~k nai'7and1or secoruiarv water barrier work at s<1 J ~ .AI e..W baN c..i:.., <br />~- (ctn:le one) . (Job Sita Adclrc88) <br /> <br />,- ~~~rbiJ\S\ fL. )3~L..\~ <br /> <br />Based upon that examination I have determined the installation wu done according to the <br />~;tigaDon Retrofit Manual ~..ed OIl SS3.844F.S.) <br /> <br /> <br />Signature <br /> <br />STATE OF FLORIDA <br />COUNTY OF . <br /> <br />":7SC;bed--~~~daYof ~I~ <br /> <br />Notaty Public, State of Florida <br /> <br />. 200S> <br /> <br />;tJ Howry Pubic StIlle Of Flartda <br />1-... , ann-Itln Rpwl <br />:.. ~ My CommlelllCln OD78'.10 <br />~"'IIIt;; Ex;lre10112<112012 <br /> <br />C\...I"\'S~ R--I~_ <br />(print, type or stamp name) . , <br /> <br />Personally known ~ <br />Produced Iden1i1ication_ <br />Type of identification produced. <br /> <br />Commission No.: <br /> <br />· Cicneral.. Builciiag. RaDclentilll, or llootins Conaacr.or or IIIJy iDdividual CS!ified UDdIr 468 F.S. to IDlIkClsudl Ill. <br />inspection.1Dc:ludc photognspbs of each plane of the roofwitb 1hcpc:nnit # or address # c:lCl1l"ly shown mIrkccl OD the <br />deak far CBCh iDspeclicm. <br /> <br />lOO/lOOl2J <br /> <br />XVj LG:9l 800G/Pl/LO <br />