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t<esidential Roof Ley-In Affidavit
St Lucie County, Public Works VED
Code Compliance
Building Permit # (J 4/ ~ -I ÚJ 0 8
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Owner's Name Ie ~
Owner's Address }3 g ç¿ ~41/1ètu
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.
};sI4l7 11 ~£&
HOMEOWNER'S SIGNATURE
S~a of Notary
b~;,~ :.J ~/~
Type o~lTint Na
li~ "~~"~"'" DORIS J. PELTON
CO~aNo.cOMMISSION#DD6104~S 1) Commission No.
r~.).~.~¿~j EXPIRES: OctODer ~l, ¡d)IO
'it \;!¡.....~~ Bonded Thru Notary Pubic Underwriters
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No' . n y Original Notarized Copy will be accepted.
()0011 ~ Ilifr~
OWNER/CONTRACTOR'S SIGNATURE
STATE OF FLORID~
COUNTY OF ~. ~~~
The foregoing instrument was acknowledged
before me this L?day ~. , 2a2?by
, who is personaI1y
known t e or who has roduced
~ as i entification.
Cml revised 1/17/2007
ST ATE OF FLORIDA ¿ ~
COUNTY OF ~~ L/¿ ~ ~__
The foregoing instrument was acknowledged
Þefor~ this~ d~ .~ , 20'-,Zby
J..PÞv-t. ~.A./L../ who IS personaI1y
known to e or who has produced
- as Identification.
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