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02/24/2010 09:00 FAX 51001/002 <br /> --1, , . • <br /> .1 <br /> . . • JURIiSDICTJONlOF YOUR. CHOICE . <br /> ...BUILDING DEPART IENT -' <br /> Permit# i. 0 <br /> C. 9117/07 <br /> ¶[n pection Affidavi . . <br /> ... /Engineer/Architect; <br /> I +" `; '.--C . ;, • )C, `r 1 c . + �> 'Z' ", -, ,licensed as a(n) C /Engm Inspector* <br /> (please print name and circle Lie_ 'Type) `FS 468 Building p , <br /> License #; . <br /> C c " ! , I did personally inspect re roof <br /> d ' k nailinz.and/or secondary water barrier work at (Job site Address) <br /> . I _.}. . 7 11 C <br /> Based . A n • - t examination I have determined the installation was done according to the <br /> Hi. ; u. gation Retrofit Manual (Based on 553.844 F.S.) <br /> . Signa k' \ <br /> . . <br /> . . <br /> • <br /> STATE OF FLORIDA • <br /> `; ; 0 COUNTY OF ' -_. <br /> • S worn • <br /> to and subscribed before me t � '2 da of b - c 4 r L-L(..., i . 260 <br /> 1 <br /> By i l )c. y.: )(2 i l ., <br /> . ' Notary Public, State of Florida <br /> I i i , <br /> • �.. V <br /> � SUZANNE DOUGLAS•ALLEN <br /> (hint, <br /> e; stamp name) <br /> 4 s Nolary Public - State o 1 Florida y" "�' <br /> • (M ... m Commiss E <br /> "i xpires Oct 2 2011 1 <br /> %r, '' 0 mma \ <br /> c , .. Co bn - # 00714319 Commission - N° -: <br /> '' %�; '�' Bord <br /> ' � � rough N ational ! <br /> Per mown ..;.,,,� , , . . Nofary Assn. <br /> Produced Identification i <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 # clearty shown marked on the <br /> deck for each inspection. . <br />