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'1esidential Roof D J-In Affidavit
St Lucie County, Public Works Department
)Code Compliance Division
Building Permit #
04 I ?- - dOL( r-
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RECEIVED
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St. I ~Cle lìrJ~O
COon" I
. ~y! FL
Owner's Name
Owner's Address /..s- 5 0
,
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.
STATE OF FLORIDA ~ .
COUNTY OF ..J;t '-, I ,J
- .
The foregoing instrument was acknowledged
befor~ me ~his L day of ~, 20!.J, by
íJ~lrk. 0 Mul:t ~personally
known to me or W 0 has produced
,.". as identification.
Signature of Notary ~ .
JI (8./~~ II. Ail
Type or Print Name of otary
Commission No. .ÞÞ Ý¿l1 ç? (Seal)
STATE OF FLORIDA ~ .
COUNTY OF \Í.:Í I~'-
~hl ¡J at re Ã~?¡1 d¡
Type ::tnnt Name of Notary
Commission No. ,ìlJJJ, ~ 151 (Seal)
No Faxed Copies, Only Original Notarized Copy will be accep~~~'f.fIk:" Shir,~y.A. Ria"
Cml revised 1/17/2007 ,,'\~'!..'ffb, Shirley A. Riall ff{A\~ Commission # 00462759
~QfA· ··Æ~ - ,. :!C- · S Ptember 28 2009
€:[ . y~ Commission # OD462759 ~~i:¡';r'f~~~ Exp're~ain ~nsuranc;e.lnc. 8OO-~85-7D19
-;.~... ...~ Expl'res September 28 2009 "i"...,' Bonded Troy
, ~......of:tS" t
',,~:~,\' Bonded Troy Fain - Insurance. Inc. 800-385·7019
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~~ \\~ ~1 DATE: ;) / ()/07
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PERMIT NUMBER
OY¡cII· "{)OV.J
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ATTENTION: RAY W AZNY, BUILDING OFFICIAL
I
, (OWNER/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 . S . - ~ / ¿
ADDRESS /53D .~ ~
OWNER'S PHONE NUMBER 7 7 1- -S 'J 6
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