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Residential Roof Dry-In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
Building Pemrit # D ç- () 3 - I (.,"7 b
Owner's Address
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Contractor
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I MAY 1 '1 2007
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IXlY:. . ' '.'--:'_"'. '
¿0Ç;' 13 S----rE7(
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IS L
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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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SIgnature of Notary Signature of Notary
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Type or Print Name of N°tatJofEtRIESA PAIl:UMi80 TyPe or Print N~Aí/';UMBO
No+.ry Publíic, State of New York No+.ry Publiic, State of New Yor"
C·· N No. 14-4508861JC'. ~]) C· · N No. J4-1Q.()~J¡;i
01l1.m.1SS10n CQ.".'i'tod:.. Ðwld\6h ~ç..." OmITIlSS10n 0.' ~1I8Uf:ed ill Q.~t!"'ffiJc.ounty
cerli'fied in We,stchester County1'\... 3 f), CÐrli'fie-d in Westchðster Counfy'"'t\__
No Faxe~ë¿pi~~PirÖ';;í~ Jb~Ígin~I~;arized Copy wiltb~71~cr;;t~d:r!~ 13, 19'.vec.3'.~8
OWNER/CONTRACTOR'S SIGNATURE
STATE OF PLORlDA IUew~ort
COUNTy OF ~)-\-C~S5
The foregoing in$trument was acknowledged
before me this ~~ay of "'~, 2Q:>1, by
9 cur'Q:'í"Ct... ß. \t)e~( , who is personally
known to me.~d
48 idcntifi(.ãLi.un.
Cml revised 1/17/2007
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HOMEOWNER'S SIGNATURE
~--. ---- -.._- "_. - ----------.--- '---.- - -------. _. - .- '-. ----,-- - ---~-
ST ATE OF FLOfUlt^~ New '1 ork
COUNTY OF \\r\'LbL,,:>s
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The foregoing instrument was acknowledged
_before me this j~ay of ~~, 2(01, by
~1..Y\P(1.Y4 €-\)(hìC'\.\ ~~, who is personally
known to meJOF\VRO has þ.f6dnced
-as is@Btification.