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DATE:
PERMIT NUMBER all d-.- . /&0 þ"
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
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I_/~&~6~¡Jlcd(¡Mj-)/yZ?~ , (OWNER/BUILDER),
AM REQUESTING THAT THE ABOVE PERMIT NUMBER BE RENEWED. I
UNDERSTAND THAT lMUST SCHEDULE AND PASS ALL NEEDED
INSPECTIONS FOR THIS PERMIT TO BE FINALED.
OWNER'S ~A ~
ADDRESS / l~- /v/I'; Þ / (V¿U ~
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OWNER'S PHONE NUMBER 7 /7 ~r?'j.~ ..:-- .1Ø·'/ -'
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R'S SIGNATURE
· :esi~ential Roof DI J - II.... Affidavit
5t Lucie County, Public Works Department
Code Compliance Division
Building Permit # D'-II Â. ....ll.,D~
Owner's Name BDQi7/4I'A ('9?~&Zf~ J
Owner's Address ¿ 7 ~ - )1 E;P, )3)j) 1:) AJ
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Contractor
Contractor's Address
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 installation of these materials.
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OWNER/CONTRACTOR'S SIGNATURE NER' SIGNATURE
ST ATE OF FLORIDA
COUNTY OF
STATE OF FL£~ ..
COUNTY O~ ~~¿~
--
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
19nature of Notary
-J ~/~
Type or Print Name of Notary
","'!J""II. DORIS J. PELTON
!ft~ MY COMMISSION # DD 610458.
~:-&l"¡ EXPIRES: October 31, 201~
~~.....ft:.~ BondedThru Notary PUÞtIo uncH!rwrnera
No Faxed Copies, Only Original Notarized Copy will be acce ,/lr. --.
Type or Print Name of Notary
Commission No.
(Seal)
Commission No.
Cm] revised 1/17/2007