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06/03/2010 07:34 FAX Z001/001 <br /> • <br /> , • . (.0 - -. i? — . t• O • • . <br /> .. - b ) 3 � 8' o ao ? 1 <br /> • . JURTS�DICT ON OE YOUR C$OICE . - - . • <br /> . :.BtTI U)ING- � EP.AR N'•r <br /> • . • RE: Pemlit# 1 ©S 3 Z " . • ' : - . " 9/17/07 ' - . • <br /> • <br /> • - 'Inspection Affidavit - . . • <br /> .I ��.uu 1 •�7�- h c�P c.� - . • • .jicensed as a(n) Contractor* /Fngineer /Architect; <br /> . . . (please peat name and dude Lin Type) - TS 468 Building Inspector* <br /> • <br /> License #; ' C_ C' • �9 5 3 i 3 i4 : _ • <br /> • On t3r'about du- 2 " 2. b i d , I did peisamally inspect rag! <br /> • (Dee &time) .. : . " <br /> • deck nailinf.and/or seconday water harrier work at k C';or4 i s c are c�1 , • • <br /> . (circle one) ' • • . ' " ( Job Silt Address) - <br /> � � -. , 1 t 15 � • <br /> - <br /> • Based 1 . 11 : examination I have det®ined the installation was done according to the . <br /> • <br /> • g..... - -` i. _..on Retrofit Mortal (Based on 553.844 F.S.) <br /> . 4110111 • • • . - . .. . • . <br /> S i JI : 111 . 1 .. <br /> 1 . <br /> • <br /> - STATE OF FIQRIDA - <br /> COUNTY OF a"xx Zb L cs <br /> • <br /> • • Sworn to and subscribed before me this > day.of 3 ,,r .. 290... • • B -. . <br /> NotaryPnblic, State ofFlorida <br /> • <br /> gy �pp..,,,,�, { � , u <br /> (Pain ,, ■1 . m % DOUGLAS-ALLEN <br /> 1 � .� Notary Public - State of Florida <br /> i C. - •_ & Common Expires Oct 25, 2011 <br /> . <br /> known. - Bonded Th rough Nati N <br /> ,.1111.... <br /> Produced Identification t „ -_ , °� Assn. • • <br /> Type of identification produced. ~ ' <br /> * General, Building, R esidmtial, or Roofer Contractor ar coy individual oeetiZad under 46s F.S. to melee such an <br /> inspection Include Photographs of each plane of the roof with the pelt *or address* clearly shown =doe nu the <br /> . dedc fur each i°'='' . • <br /> 1 . <br /> r <br />