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Oct 29 09 11:11a Rick Gavin 352-567-5034 <br /> ( 3- - 7e5o co 2- i <br /> City of Zephyr' hills <br /> ING DEPARTMENT <br /> RE: Permit # _ 3 q 7 9117107 <br /> Inspection Affidavit <br /> e tc ,licensed as a(n)* /Engineer/Architect, <br /> (please print name and circle Lic. Type) FS4 Building Inspector* <br /> License #; ,&O 4'»t/ <br /> On or about , I did personally inspect the roof <br /> - <br /> eck nailin and/or seconda water barrier ork at 57 T _r ,ze -111 z# <br /> , <br /> (circle one) (Job Site Address) <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 FLOWA <br /> •COUNTY OF 3'4 4r—Cr <br /> e h <br /> Sworn to and subscribed before me this. tci <br /> day of e-r . 200 <br /> By , <br /> N • :16 • State of • da <br /> 744 JANICE /4. HEWS <br /> • - hAY C0ISSKDNl 00 922207 <br /> , <br /> • EXPIRES: September 10. 2013 <br /> Banded Dint Went Puede Underfelt= I 1, type,- • name) <br /> • • <br /> Commissi • • o.: ciaal- 01 <br /> Personally known %.-/Or <br /> Produced Identification <br /> Type of identification produced. <br /> * General, Building, Residentiad, 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 pamit # or address # clearly shown marked on the <br /> deck for each inspection. <br />