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Residential Roof r 'y-In Affidavit
5t Lucie County, Public Works Department
Code Compliance Division
Building Permit # 0 c§ ¿) 2.. - /" 9 yY RECEIVED
Owner's Name ;I) A GO 6 £1< T è G S A /\/ 0 ¿) ~R 23 2001
St. LlJEC~/Tì¡NG
/ / þ" Ie C
Owner's Address / ?¿J () U æ:ú!4/f U¿¿. ~ Olint!" F"L
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.
OWNER/CONTRACTOR'S SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this _ day of , 20_, by
, who is person all y
known to me or who has produced
as identification.
Signature of Notary
Type or Print Name of Notary
COIl1l11ission No.
(Seal)
STATEOFFL~w. ' ,
COUNTY OF ,.' (1 f:
Type or Print Name of Notary
Commission No.
No Faxed Copies, Only Original Notarized Copy will be a
Cm] revised] I] 7/2007
DA TE:
PERMIT NUMBEK2 c>2 {/ 2 - / 9 ~ç'~
,/
RECEIVED
APR 23 2007
St :E~N/lìTING
· LJCle COU. nty FL
~
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
I
, éRTó
!/
~ ,a/t¿rz~, (OWNER/BUILDER),
AM REQUESTING THAT THE ABOVE
IT NUMBER BE RENEWED. I
UNDERSTAND THAT I MUST SCHEDULE AND PASS ALL NEEDED
INSPECTIONS FOR THIS PERMIT TO BE FINALED.
OWNER'S ' J' / / ~ ~_-=-
ADDRESS /J?¿J ¡) (/ r7hd éU4, /-Y/ ¿
OWNER'S PHONE NUMBER ('7 '7:) Y ~5/ - 0·/ cfO