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City of Zephyrhills <br /> ;BIM DING DEPARTMENT <br /> RE: Permit # 7ri1 9/17/07 <br /> Inspection Affidavit <br /> ,licensed as <br /> 1 C J �� 15i/tan/Lao, li d a(n) /Engineer/Architect,. <br /> (please print name and circle Lie. Type) FS 468 Building Inspector* <br /> License #; _CC / S 1 <br /> On or about ,_/.) vie t + 00 ,1 did personally inspect the roof <br /> (Date & time) r <br /> deck nailin a nd/or seco wat er burner ork at 2 7 I y1 y r u A pe <br /> circle one) (Job Site Address) <br /> Z' .h r. I <br /> Based upon that examination 1 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 this o2 lay of Li u r . 200 Oct <br /> By SCti` 81 Ct LbA__ . <br /> Notary Public, State of Florida <br /> (`-& <br /> (Print, type or stamp name) <br /> Commission No.: <br /> Personally k sown _ or <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 /> • <br />