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01/11/2010 12:36 FAX al001/001 <br /> • • • . . • <br /> • . . <br /> • ' <br /> . , • <br /> . . , <br /> . . . . <br /> , . . <br /> • . <br /> ._._ . <br /> ------------- _ <br /> . . <br /> - . • <br /> • -JURISDICTION : OF YOUlt.CHOICE. • <br /> • . : 'BUILDING 13EPAR.TMENT . •• <br /> • . . <br /> .. . . <br /> RE: Permit # cr 8 S 0 • . . 9/17/07 <br /> • . <br /> . • . • <br /> • Inspection AffidaVit • • . • <br /> . , <br /> . . • <br /> • • <br /> . . . - <br /> .1 Pam. I '3c..bait', e. Y ' ,licensed as a(n) Contractor* /Engineer/Architect, <br /> . (please print name and circle Lic. Type) . TS 468 Building Inspector* • <br /> • <br /> . - <br /> License 4i; • C.Cco58 , i Si4 • . . . <br /> - . <br /> - - On or .-101. kJ i 1 20 t 0 ' , I did personally inspectthe roof' <br /> (Date & time) . . <br /> -------,--___. . <br /> cnailink and/or secondary water barrzerwt • <br /> , <br /> (circle one) - (Job Site Address). . <br /> r* <br /> . 3.8 4 t t..,/e. eG 2, ee kJ NA L.I. A G.E. D r - <br /> • <br /> • <br /> Based upon that examination I have determin ed the installation was done according to the <br /> • Hurrican , 6 I ti: : on Retrofit Manual (Based on. 553.844 F.S.) <br /> NA% 11 - • . <br /> Sigiaatur li ' . . <br /> . , <br /> •--,... • <br /> • STATE OF FLORIDA <br /> COUNTY OF <br /> 1 <br /> • Sworn to and subsribtd 1 me this 1 I: day, of Zgakote.q . 209. E010 <br /> It By . <br /> . • : Notary Public, State of FloriAa <br /> . ' ' v ' — ' S117.kliNEDOUGLAS-ALLEN <br /> ' - '''''''''''''''';'', Holary Public • State ot Florida <br /> -.„ •-0,. "... • - 4 4pice.a. t ut.i.2 5,2011 <br /> ■7 <br /> Perscmally kuown or :;, sor,dcerrtmrousgt;';'Y 1-1Nstional4171.41o4tary19Assn - • <br /> Produced Identification I <br /> Type of identification produced. • - • <br /> . <br /> * General, Ehdlding, Residential, or Roofing Contractor i:n any individual certified under 468 F.S. to mak* such an <br /> inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown romrir*d on the <br /> ‘1.....k L. —1. ;.. .,......1......... <br /> . • <br /> , • <br /> . 1 <br /> - I <br /> '1 <br /> -1/,' <br />