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DATE: ~?ð·;>t>v'7
PERMIT NUMBER
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OS-Ó L~/~~ ~O~ ~~~~'L~
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
I N((;~o{~
, (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
ADDRESS
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W~ R LVP~ kJk(Vc
7 77- -- S-9 ~_,-- b {~2-
OWNER'S PHONE NUMBER
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/10 f~·
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r ~sidential Roof Dr' ·In Affidavit
.,
St Lucie County, Public Works Department
Code Compliance Division
Building Permit # OS- b 2 - l7 l S-
Owner's Name N l c kò f ~ (~c 0 ~k(2 <:...:)
Owner's Address 'W 2-. 1< l Ù t2 ~A-l {c
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 8t Lucie
County of ility with respect to the installa· of these materials.
H MEOWNER'S SIGNATURE
STATEOFFL~ID~ r
COUNTY O}> t· ~
STATEOFFLO~ ~..
COUNTY OF ~.
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The fore.gO,in.g instrument ~. asknowl~dged
before me thIS ~ day of . , 20ð r, by
ly-'t:~Lf/JS ·It:CtfRßßl.~ who is personally
known to me or who has produced
.rtd. 1:>12· L/~ as identification.
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The f,. OregOing, instrument ~~OWledged
befpre me thi~dQ. day of 20~by
/Y1(ïltJLIlf ~l}1UJ, who is personally
known to me or who has produced
r tJJ· [;)e. ¿ t~ as identification.
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-- Type or Print Name of Notary /
Commission No. (Seal)
SIgnature of, ry
,(k 1 ~ J;. µtL¡1?p.µ£rj/
Type or Print ameofNotary ~
Commission No.
(Seal)
Cm] revised 1/17/2007
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