The Contractor/Owner-Builder named above accepts full responsibility, and indemnifies and holds harmless the City of Temple Terrace for any liability that arises due to having missed the In-Progress Inspection for the above named permit and certifies that all work performed complies with the Florida Building Code Sixth Edition (2017).
State of_____________
County of____________
The foregoing instrument was sworn to (or affirmed), subscribed, and acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of __________, 20__ , by ___________________ (name of person making statement), who is personally known to me or has produced ___________________(type of identification) as identification.
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