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U <br /> j j <br /> ," <br /> 7! <br /> City of Lephyrit lls i <br /> BOLDING DEP!'RTNZENT <br /> RE: Permit* 9c7 `7 9/17/07 1 <br /> 1 <br /> Inspection Affidavit 1 <br /> I ,.1 Ge .,64 c A,, ,licensed as a( . ` . ontract e • /Engineer /Architect, <br /> (please print name and circle Lie. T F ' 68 Building Inspector* <br /> j <br /> License #; e. CCOSI "S1 _ il <br /> O or about J �/ / o , I did personally inspect the roof <br /> mate & Vi e) <br /> deck nailing and/or secondary water barrier work at . 3 / / it0 Q-o x lrovl (71, <br /> (Job Site Address) <br /> - it1hl Is F 1 <br /> Based upon that examination have determined the installation was done according to the <br /> Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.) <br /> .04.E I <br /> Signature <br /> STATE OF FLORIDA <br /> COUNTY OF � ` II 1 <br /> Sworn to and subscribed before me this, y of VUI. . 200' <br /> By &c -- 2)lcx I <br /> Notary Public, State of Florida 1 <br /> CONj C% <br /> 1 <br /> (Print, type stamp <br /> or name ) <br /> Commission No.: <br /> Personally known or <br /> Produced Identification <br /> Type of identification produced. r <br /> * General, Building, Residential; or Roofing Contractor or any individual certified under 468 F.S. to make such an t <br /> inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown :narked on the , 41 <br /> deck for each inspection. <br /> .. 1- CORI MN I EOU&N <br /> ‘G NaMy Pr - SUM el Fl <br /> CanriMo , El�ieeAoq tt, X010 <br /> „ - <br /> , Cc rnIsion f 00 581809 <br /> &yodel By National . Assn. <br />