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02/14/2007 21:36 7724625267
ST LUCIE CO
PAGE 01
Residential Roof Dry - In Affidav,·
St Lucie County, Public Works Department _l 7lJ.
Code Compliance Division
B uildin.g Permit # O,C¡ OL/ - 0 q 0 ( "
Owner's Name 6EDrCh£ HI!\J ~L£"\I
PERMITTING
Owner's Address ,1l.s; M ED 1/£ iLL-At )Elt0 8 ~I) h. {;. St. Lucie County, FL
mDr?Jl L£ftr)IflE SY'5TBl1~ JOC.
Contractor's Address qtJ/ Siu R Q-. fJDmPPrúO I6E&CtJ Fl. 33Db9
,
r!M£fdð't~ I1Df ~ f:V'htl+
RECEIVED
APR 0 5 2007
Contractor A bt)/16.:C£D
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 tbe Florida Building Code and Chapter 9
of the FIo.rida 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 Luci.e
Connty of any liability with respect to the installation of these materials.
~Oýf
QWNERlCONTR.A TOR'S SIGNATURE
STATE OF .FLORIDA
COUNTY OF PJfLj)lJJ/tlLb
ST.A TE OF FLORIDA
COUNTY OF S~ L-u~ If
The foregoing instmm.ent was acknowledged
before m.e this -L day of mA f.!H, 20J!], by
ml~H1tEl~ Uu.lfA:j , who is pewnaJly
known to me or who has pr.oduced
as identification.
The foregoing ínstrument was acknowledged
before me this 30 day of "1ttré:h , 20Q2, by
fLéàfLbE fI/D~, who is perSonally
knq~ me or who as produced
as i.dentificatìon~
Signature of Not
m~1Yþ ·0
Type or Print N 1ri>taI'Y
Commission .No.
(Seal)
Commission No.
(Seal)
No Faxed C~Ries, Only Original Notarized Copy will be accepted,
Cml revi¡;cd I/J 7/2007