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~esidential Roof r y-In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
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Building Permit # {;í&~ - ø/
Owner's Na
Contractor's Addres
I certify that: The required Lapping and Fasteners of the underlayment
(roof felt); hot mop, if required and flashing have been installed in
accordance with Chapter 15 of the Florida Building Code and Chapter 9
of the Florida Building Code, Residential with approved revisions and
meet the requirements of the product approval.
I understand that by executing this Affidavit I hereby relieve St Lucie
County of any liability with respect to the illstaIIation of these materials.
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this _ day of , 20_, by
, who is personally .
known to me or who has produced
as identification.
Signature of Notary
Type or PrÜlt NaJne of Notary
Commission No.
(S eal)
C:::=RÕMEOWNER'S SI NATURE
1
STATEOFFL~1 .
COUNTY O~ . U&l 12
-
The foregoin. g i9strument was acknowledged
~e me this.. l¡ day of Î, 20-1, by
'FΟ;J7 4-æqq ¿ ~ho is personally
known t me or who has produceçl
ã, as identification.
"--
Cm 1 revised 1/17/2007
No Faxed Copies, Only Original Notarized Copy will be accepted.
DATE: arc7ß7
PERMIT NUMBER CW' ~ - ¿?d./ 7
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
, (OWNER/BUILDER),
AM REQUESTING THAT THE ABOVE PERMIT NUMBER BE RENEWED. I
UNDERSTAND THAT I MUST SCHEDULE AND PASS ALL NEEDED
INSPECTIONS FOR THIS PERMIT TO BE FINALED.
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OWNER'S PHONE NUMBER \~ ~C1 ~ -Oìo2)
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,. ~
" I ".....", DORIS J PELTON .
1 f~l~~ MY COMMISSIÓN # DD 610458 ~
J!~~.~lJ EXPIRES: October 31. 201~
t '~f,iif.~,~ BondedThru Notary Public UndelWfiters
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