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Residential Roof Dry-In Affidavit
8t Lucie County, Public Works Department
Code Compliance Division
Building Permit # (J Vi d- - I ? '21
Owner's Name S> 'j-£; þ:'rflVéY '1/ k to N6-:
Owner's Address ~ C¿ ~ c:Þ ~ F .D~-7--
Contractor d) /£/ N ~ ~ B (/ L- ]) ¡~-If
Contractor's Address
c/ ,~¡
( Z_-d_~n;/t-''--
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 installation of these materials.
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· . . i'? ~. ð~
OWNER/C NTRACTOR'S SIGNATURE
H~~~~I;~~-~¿/Z
STATE OF FLORIDX
COUNTY OF ~ k. ~
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this ~ day 8--- , 20b~ by
ho is personally
known to me or who has produ~d
r-¿ ðLct. -/(p(,-9-:;. identification.
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
1~ ( -¡¿-Y,
Type or Print N ...... "'1 DORIS J. paTON
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Commlsslo ª. '¡s EXPIRES' Oc}oÞdé~2d)
~f~\t~"· Bonded Thru Notary Public Underwriters
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Type or Print Name of Notary
Commission No.
(Seal)
No Faxed Copies, Only Original Notarized Copy will be accepted.
dmg revised 12/22/2006