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OS/22/2007 00:32 7724621735
ST LUCIE CO
PAGE 02
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Residential Roof Dry-In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
BuiJding Pertnit #
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Owner's Name'
Owner's Addres
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Con tractor
Contractor's Address Po 8D~ 3fd-9 ~j PC -5ð-¿P-O~--
I certify tbat: 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 ~orida Building Code and Chapter 9
of the Floiida Building Code, Residential with approved revisions and
, meet the req,uirements of the pro,duct approval.
I understand that by executþJ,g this Affidavit I hereby relieve St Lucie
' County of any Ii bility with respect to the instaUation of these materials.
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OWNER/CONTRACTOR' S SIGNATURE
HO:MEOWNER 's SIGNATURE
~~~~FoIÇO~ r-!~ ~
The foregoing instrument was acknowledged
before me this'-~y of ~-, 20..Q.,:¡-by
~~sonaIJy
kno~1cl.m.eHor who has produced
as identificarioTJ..
Ä~ ~#UV~,
Signature of N BETTY L. LOWMAN
~OTA~ PUlllC· STATE OF FLORIDA
t~r)MMJSS'ON # DD388731
Type or Print N:aMe of NOl4\ry ~XF"Res 4/28/2009
t30NO~~ f'~RU 1·88lt.~JOT ARY1
STATE OF FLORIDA
COUNTY OF
The foregojng instro.rnent was acknow,ledged
before me this_ day of ~ 20_, by
, who 1.S personally
known to me or who has produced
as identi.fication..
Signatur~ of Notaiy
Type ~ Print N:nTJe or Notary
Com.mission No.
(Sea])
Com.mission No.
(Sea] )
No Faxed Copies, Only Original Notarized Copy will be accepted.
Cml revised 1/]712007