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r { 6 ( rv. 4, <br /> gJ3- 78'0 - (,o ).a <br /> 0, <br /> q13--?sr.-r%&I <br /> City of Zephyrhills <br /> B: 0 DING DEPARTMENT <br /> RE: Permit # t ( 36'19 9/17/07 <br /> Inspection Affidavit <br /> • <br /> I C - s A• /7 <br /> �. io s <br /> r ,licensed as a(n) ontractor* ngineer/Architect, <br /> (please print name and circle Lic. Type) uilding Inspector* <br /> License #; cc C / 3 .20 3 7 3 <br /> On or about 1 , (ka2tie I.01 . la : s 6 I did personally inspect the roof <br /> & time) <br /> deck =Eli %; , or seconda water barrier work at <br /> G 11. G (circle one) (Job Site Address) <br /> a <br /> X938 /7 s1- <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 /> r �, i 2 <br /> Signature <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> Sworn to and subscribed before me this . - day of _/V c.iV 4 l .. . 200 Q <br /> By 06Atif ` <br /> Notary Public, State of Florida <br /> \ r type or stamp �¢2r <br /> to � t, typmp na <br /> wh anon. 0011•5 2e, 20 name) <br /> Commission No.: <br /> Personally known or <br /> Produced Identification <br /> Type of identification produced. 1 LC;)-- i q N f., LA42-1^ s <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 permit # or address # clearly shown marked on the . <br /> deck for each inspection. <br />