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<br />rCiity ~of .Zepbyrbills <br />BUlIJDING DEPAR~MEN~ <br /> <br />RE: Permit # ~Q '4 <br /> <br />9/17/07 <br /> <br />Inspection Affidavit <br /> <br />I tJ/ / //;11 Ifl /)/.1 x:- ~ <br />(please print name and circle Lie. Type) <br /> <br />,licensed as a(n) Contractor* /Engineer/Architect, <br />FS 468 BuIlding Inspector* <br /> <br />License #; t!.CC /32 h 9/9 <br /> <br />On or about <br /> <br />du,,~ /f? .2ooR- <br />(Date & time) <br /> <br />~--:--- <br />deck nailin!.!!}Jd/or secondary water barrier work at -5:543 S.3 4S- <br />(circle one) (Job Site Address) <br /> <br />, I did personally inspect the roof <br /> <br />/() !;f .s-f- , <br /> <br />"'--- <br /> <br />Based upon that examination I have determined the installation was done according to the <br />Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br /> <br />~LL--~/ <br />Signature <br /> <br />STATE OF FLORIDA <br />COUNTY OF -fl..,! <br />Sworn to and subscribed before me this Li..:.day of <br /> <br />BY~AL ~~~ <br /> <br />Q-,~ <br />(J <br /> <br />.200Y <br /> <br />Personally known Lr <br />Produced Identification <br />Type of identification produced. <br /> <br />Notary Public, State of Florida <br /> <br />SA -e IT: J'$" 11 -+L""F",,) <br />(Print, type or starn name) <br />Commission No.: .JLj) S-&, 2 S-~ 2- <br /> <br />* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F .S. to make such an <br />inspection. Include photographs of each plane of the roof with the pennit # or address # clearly shown marked on the <br />deck for each inspection. <br /> <br />: ""'~"~"'I, SHERRI LYNN THOMPSON <br />j f'~\it...~~ MY COMMISSION 1/ DO 562562 <br />I_'lt'. .~ <br />. ~W EXPIRES: June 11,2010 <br />~w.-'- Bonded Thru Notary Public Underwriters <br />