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<br />City of Zepbyrhills <br />BUILDING DEPART:MENT <br /> <br />RE: Permit#~ <br /> <br />9/17/07 <br /> <br />Inspection Affidavit <br /> <br />I J<, II." ~~ <br />(please print name and circle Lie. Type) <br /> <br />,licensed as a(n) Contractor* /Engineerl Architect, <br />FS 468 Building Inspector* <br /> <br />License #;CCL l3d..S.:roS' <br /> <br />On or about..9 / ::J::J./a$l l~ , I did personally inspect the roof <br />(Date & rime) <br /> <br />~~nd/or secondarv water barrier work at ~ 7/14 q """ .5+. <br />~~ (dn:leone) (Job SiteAddre9s) <br />2e-Ph'"/rh;l\~ 1 a. j3S~~ <br /> <br />Based upon that examination I have determined the installation was done according to the <br />Hurrican~fjt Manual (Based on 553.844 F.S.) <br /> <br /> <br />Signa~ <br /> <br />STATE OF FLORIDA <br />COUNTY OF <br />Sworn Io~Ded befure~.~ day of ~\.....-,: <br /> <br />~ -. <br />. Notary Public, State ofFJorida <br /> <br />r1r;~{\a- ~~. <br />(print) type or stamp name) , <br /> <br />. 200.2 <br /> <br />.NP ~ Notary Pullllc Sta.. Of FIortd. <br />'~.-.,. CIlfI,liBn Ryrnafl <br />~c f"i fttyClIIlImINlonDD75,e10 <br />... o. floG"" Expire. 0112412012 <br /> <br /> <br />Personally known OJ: <br />Produced Identification_ <br />Type of identification produced. <br /> <br />COmmission No.: <br /> <br />~ <br />.. Gencral, Building, R.eajdeptial, or R.oofing Contractor or any individual certified UDder 468 F.S. to mBke such BD <br />inspection. lftclw'le photographs of each plane oftbc roof'Wi1h tbe permit # or Bddre8s '* clearly shown maxbd on the <br />dcdc for each mspect.ion. <br /> <br />lOO/LOO It! <br /> <br />X~~ G8:0L 800G!PG!60 <br />