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City of Zephyrhills <br /> 2 BUILDING DEPARTMENT <br /> (� <br /> RE: Permit # q / 2 5 9/17/07 <br /> Inspection Affidavit <br /> I ,� Cvi ` f i elgt a.,:z g 4.1 ,licensed as a(n) Contractor* /Engineer /Architect, <br /> (please print name and circle Lic. Type) FS 468 Building Inspector* <br /> License #; (Y C or Jf ,c— 7 <br /> On or about i aJ a ! ( , I did personally inspect the roof <br /> (Da / (..) <br /> timee) <br /> ck nailing and / or second • r ',e a te 4. - 17:1 rrier , o rk at ,..5 6 0 1 J -7 r - 7 -- , <br /> c,irc.1i ,,,.. (Job Site Address) <br /> Ze pi/tf vI1 /// // . <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 /> Signature <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> Sworn to and subscribed before me thisrday of a (L yvi . If . 200_ <br /> By €COtt l (CLCkCVict . <br /> Notary Public, State of Florida <br /> Print <br /> ( , type or stamp name) <br /> Commission No.: _ <br /> Personally known or <br /> Produced Identifica io <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. _ KEOUGH I et: � " CORI ANN KEOUGH ' <br /> .'' � Public - StI or Florid. <br /> • Co m�.ion Expires hp 17, 2010 <br /> '. + ./ Commission 0 DO 588509 <br /> Eondsd ey NNfon.l No try Aesn. <br />