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City of Zephyrhills <br /> :BUILDING DEPARTMENT <br /> RE: Permit # 4-1-02 9/17/07 <br /> Inspection Affidavit <br /> I , icensed as a(n) Contractor* /Engineer /Architect, <br /> (please p n e and circle Lic. Type) F 468 Building Inspector* <br /> License #; <br /> On or about 7 <br /> , I did personally inspect the roof <br /> (D time) <br /> deck nailing and /or secondary water barrier work at r" <br /> Csk4-t-Qek-7 <br /> ki de one) (Job Site Address) <br /> • • '-R--w() Q <br /> Based upon that <br /> 4 <br /> 11 ' e ation I have determined the installation was done according to the <br /> Hurricane Mitig. Retrofit M.- . Ot ased on 553.844 F.S.) <br /> Si us.:,,' . <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> Swo i to and subscribed before me this 24day of S / . 200 j <br /> BY L.,,,,__,. <br /> teb . . <br /> _ <br /> 9 / / Notary Public, State of Florida <br /> D 4;1/4,, JACQUELINE BOGES <br /> (Print; #y, w • , :V 1 `V ;.1 010 <br /> '' °::. <br /> of � ,,, 1 7M r !!NNf1MIM M4Mq'OtP <br /> / Commission No.: <br /> Personally known ✓ 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 />