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City iof Zephyrhills <br /> :BUILDING .DEPARTMENT <br /> RE: Permit # 9/17/07 <br /> 3Inspection Affidavit <br /> L • ��� <br /> I . ,r ,licensed as a(n) Contractor* /Engineer /Architect, <br /> (please print name and circ e Lie. Type) FS 468 Building Inspector* <br /> License #; 3 86 <br /> On or about .� ;703'4' <br /> • <br /> , I did personally inspect the roof <br /> ( ( Date& <br /> deck nailing and /or secondary water barrier work at <br /> (circle one) (Job Site Address) <br /> Based upon . at examination I have de - • • ed the installation was done according to the <br /> Hurric. / .ti on R • : • • anual (Based on 553.844 F.S.) <br /> N ft1 <br /> Sig <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> Sworn to and subscribed before me this °KG day of . 200.0 <br /> By r <br /> Notary Public, State of Florida <br /> (Print, ' s § �:a. -i, i�i� •.- D <br /> r, 734406 <br /> �x:1116 %1Utry 22, 2012 <br /> Co.. inr e." <br /> sonall 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 />