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01/22/2010 09:55 8137801805 BARTLETT ROOFING PAGE 03 <br /> City of Zephyrhills <br /> B. 1 0 DING DEPARTMENT <br /> RE: Permit 1 tbI 3 9/17/07 <br /> • <br /> Inspection Affidavit <br /> T � <br /> �( J , as a(n) ' Contractor * /Engineer /Architect, <br /> (please print name and circle tic. Type) FS 468 Building Inspector* <br /> License #; c S oZ <br /> On or about 1.- 22.- /0 • • , r did personally inspect the roof <br /> (Date & iime) <br /> • <br /> deck nailing and/or secondary water barrier work at D41,1 I , ap ,Q, <br /> (circle one) (Job Site Addzeis) <br /> SS j . Z ' j <br /> Based upon that examination T have • - - • • ' • ed the installation was done according to the <br /> Huai . • . Y lion Retrofit .0 (Based on 553.844 F.S.) <br /> Si e <br /> • <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> Sworn to and subscribed before me this. Z day of r.(aly . 200L <br /> By _ y <br /> Notary Public, State of Florida <br /> (Print, 41' \.':! .1.11. +., , - •1:. BOG ES <br /> • <br /> •*= e miss o n rD621833 <br /> �,�,,, -:.. `} Expires December 12, 2010 <br /> CoMIIAiss ABU. Thn+T ''''"'"'""" ' 04040,9 <br /> P ersonally 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 /> • <br />