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J{esidential Roof Dry-In Affidavit
8t Lucie County, Public Works Department
Code Compliance Division
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Building Permit # ()L/ I r2 - D g () Iliy~Wu1-!J'"
Owner's Name S-\-eve'i'. Y \S~,J",,~ <' I De bl~'(Â~ f\"' -f;.'P\¿~~
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Owner's Address :; ~ õ )... My ç +\ ~ ~,~ €- , (0 ç-T \/\~c-ce I fL. s y q 2( ~
Contractor J t? b~c +- ~c IA ""^ ~ "( I ~ ß \< 0 0.( '^ j , T ",c.. 1
Contractor's Address L-\ C\~O OCeb..~ ~C-'J M~¿¡~+L'"ð'" , (1,/ '3>3'050
I certify that: The required Lapping and Fasteners of the underlayment
(roof felt) 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 in tallation of these materials.
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OWNER/CONTRACTOR'S SIGNATURE
HOMEOWNER'S SIGNATURE
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA '
¿::v ..
COUNTY OF ~...LuC-.l&
Signature of Notary
The foregoing instrument was acknowledged
before me this '3 day of .{~ ,2001 by
~~ p. ~dVl~ " who is personally
known to me or who has produced
fJr 'þL,. f6lR~- 1Cj5 -S4-4b5íiil3 identification.
1~tUM Li0 iQj
) Signature of Notary
"ar L( ;.Jea)
- .
The foregoing instrument was acknowledged
before me this _ day of , 20 _, by
, who is personally
known to me or who has produced
as identification.
Commission No.
(Seal)
Commission No.
Type or Print Name of Notary
No Faxed Copies, Only Original Notarized Copy will be accepted.
dmg revised 12/22/2006