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DATE: cf- - ( (- ¿J7
PERMITNUMBER 0 soy - JC)()~
A TTENTION: RAY W AZNY, BUILDING OFFICIAL
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, (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 .ð F_ /J
ADDRESS 7 So d. / /fC!.-r F I (! Æt/~ ífì /J G" ¡e C!/;?J ¡:¿ 3 '{- 117
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OWNER'S PHONE NUMBER 7 7 ~ If- foð- 7~ ~š
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O~'S SIGNATURE
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F /sidential Roof DrJ In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
Building Permit # () ~L1 -l QDe;:?
Owner's Name tl~C.(1Ý/4 E. (3L~Cl<
Owner's Address I $Ó ~ f~( r/cAc/J?, h -/¡E,lžC~ FL 3'-17'-S7
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Contractor (á l~) 31)
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
~
NER'S SIGNATURE
STATE OF FLORIDA
COUNTY OF
- .
The foregoing instrument was acknowledged
before me this _ day of ,20_, by
, who is personally
known to me or who has produced
as identification.
Signature of Notary
-----
· , Signl{u~e ~fNotary J
C\. r b~---r,- {t ( 'LA v-LJ{ I ~
TypeorPrintNameofNo~y
Type or Print Name of Notary
Commission No.
(Seal)
Commission No.
(Seal)
No Faxed Copies, Only Original Notarized Copy will be accepted.
Cml revised 1/17/2007