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City of Zephyrhills <br /> BUILDING DEPARTMENT <br /> RE: Permit # (1 911 / 9 9/17/07 <br /> Inspection Affidavit <br /> 1 S v 6 [ a t-k 6ti Gt /,-. ,licensed as a(4 Contracto * ngineer /Architect, <br /> (please print name and circle Lic. Type) ' 68 Building Inspector* <br /> License #; (CC U S ? 9.5 7 <br /> On or about ()LC- a3 20 0 9 , I did personally inspect the roof <br /> r: ,m <br /> deck nailing a d /or sec. : •r barrier work at 3 SS V 0 A.,/6 r' /47VC <br /> ( circle one) (Job Site Address) <br /> . zephvhr lIs - F/ . <br /> Based upon that examination I have detelinined the installation was done according to the <br /> Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br /> i <br /> ;. ii �' — / <br /> s ignature <br /> STATE OF FLORIDA <br /> COUNTY OF � rd <br /> Sworn to and subscribed before me this ,- day of LEW yu y . 200 -1 <br /> By CO- C V 1a IV <br /> Notary Public, State of Florida <br /> .. ki i__et_iyre_ <br /> (Print, type or stamp name) <br /> Commission No.: <br /> Personally known r <br /> Produced Identification <br /> Type of identification produced. <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 /> A s o' 4 CORI ANN KEOUGH <br /> 1 `' Notary Pubic • St* d RIO <br /> C l?. PIO <br /> ,.` ODD 111603 <br /> t A Bonded By National Assn. <br />