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__~esidential RoofD-.j-In Affidavit
St Luci~ COU?ty, Public ~orks D.e~~eEIVED
Code ComplIance DIvIsIon
Building Permit # (1')4/2-/42-0
Owner's Name ,-':J~^) ,~p¡;;:~ S:DA,. )
Y ()CC£l ~(' .
PERMlrrlNG
Sf. Lucie County, FL
Owner's Address
(-)/03
Contractor
Contractor's Address
I certify that: The required Lapping and s f rl¥ment
(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 installation of these materials.
STATE OF Ä,
COUNTY OF S4- LuUE
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The foregoing instrument was acknowledged The foregoing instrument w..a; acknowledged
before me this \!S day of 01~ ' 2001 by before me this Ie-day of ~, 2fJf1 by
-Í;)~"" ŸÇfét-5()......J , who is personally , whclis personally
Jroo~n to me or who has produ~ed .. §;¡.~~!~4;¡%::-:. known to me or who has produced
oJ \~~"f ~ ... 0 as IdentIflc~J;: (, L.'''fd-~-''3(),.l) as identification.
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ã'-9. ~ ~ ~Si. atureofc;lNotary
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t·øø~ ~~ _
i ~ ~ 0) Type or Print Name of ~~ Dana Ward
i ~ * a. · · €f!~\*- Commission,. DD586672
(Sea]) ~ ~ g CommIssIon No. ,,~_. . ~xpires August 20, 2010
~ 0 (J1 , ., Boftded rMJ F.. · tn....nce. lne 800-385-7019
No Faxed Conies, Only Origil&J¡otalized Copy will be accepted.
.r ëØON
75~O; IdaJLI:J
Type or Print Name of Notary
ComlIlission No.
Cm] revised 1/1 7/2007
RECEIVED
MAY 1 5 2007
PERMITTING
St. Lucie County, FL
DATE: ~f,:)/O 7
PERMIT NUMBER , 04 1.'2-/ ~ 2-Q
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
I <-VA0tJ ~GFF~~,0
,JQ)XTNPR/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.
OWNER'S ~ '0
ADDRESS b(O?J '-{ vCLCl k:J(' - ~ IT r I e.r('£
,
OWNER'S PHONE NUMBER 112-~b~- 93-:¡g
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