Fillable CITY OF CLERMONT BUILDING SERVICES WINDOW & DOOR (City of Clermont)

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CITY OF CLERMONT BUILDING SERVICES WINDOW & DOOR (City of Clermont)

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CITY OF CLERMONT
BUILDING SERVICES
WINDOW & DOOR INSPECTION AFFIDAVIT
Permit #____________
Job Address: _______________________________
I, ______________________________________, licensed as a(n) _____Contractor,
_________Engineer, __________Architect, ________FS 468 Building Inspector.
Will personally verify that the shim thickness does not exceed that of the specs, and that
the correct length fasteners have been used to install these doors/windows.
Based on that examination, I will determine the installation has been done per FBC and
the manufacturer’s engineering details.
Signature: ________________________________________
STATE OF FLORIDA; COUNTY OF LAKE:
The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online
notarization, this ______ day of ___________, _________(year), by ____________________________
who is personally known to me or who has produced __________________ as identification, and who
executed the foregoing instrument, and who did take an oath.
____________________________________
Signature of Notary Public – State of Florida My commission expires:
____________________________________
(Print, type, or stamp commissioned name of Notary Public)
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CITY OF CLERMONT BUILDING SERVICES WINDOW & DOOR (City of Clermont)

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Completed 22 January 2021

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