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<br />08/15/2008 12:42 FAX <br /> <br />~ 004/004 <br /> <br />tCity ~ofZepbyrblIls <br />BUILDING DEPARTMENT <br /> <br />RE: Pennit# &'Ocl r <br /> <br />9/17/07 <br /> <br />Inspection Affidavit <br /> <br />r ~'ll S~y <br /> <br />(please print nam~ and circle Ltc. . ype) <br /> <br />,licensed as a(n) Contractor* IEngineerl Architect, <br />FS 468 Building Inspector* <br /> <br />License #; c..CC 0 c:;g I -3~ <br /> <br />On or about ri!l, V 08 <br />ate & time) <br /> <br />, I did personally inspect the roof <br /> <br /> <br />ork at :5 f?55' I&IA stu.d <br />(Job Site Address) <br /> <br /> <br />t examination I have determined the installation was done according to the <br />i 'gation Retrofit Manual (Based on 553.844 F.S.) <br /> <br />STATE OF FLORIDA <br />COUNTY OF . ~ <br />Sworn to and subscribed before me this It( day of <br /> <br />By ?~\ ~c:.k~~y <br /> <br />/l~Jt- <br />, 0 <br /> <br />.2001 <br /> <br />No <br /> <br /> <br />Personally known ~r <br />Produced Identification <br />Type of identification produced. <br /> <br />MY COMMISSION # DO 805627 <br />eXPIRES: July 14.2012 . <br /> <br />(P ....... . <br /> <br />t. '- i.. /,L' J::i.t: - 11 .-J t i' , () <br />( .1fl :', '.'?i itll \.. i .I\}.l.."-v.....I. ".'.,',J <br />'-....-..... \' ,... ~, .... "1; v. ~,'. ~, \ <br />Commission:. 0.: l)i)~O')([:::1'j <br /> <br />.. General, Building, Residential, or Roofing Contractor or any individual certified under 468 F .5. to make such an <br />inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the <br />deck for each inspection. <br />