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¿~esidential Roof r y-In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
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Building Permit #
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REC
_ JUN 0 J 2007
Owner's Name
PERMITTING
St. Lucie Coun , FL
Con tractor
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Owner's Address
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 illstalIation of these materials.
OWNER/CONTRACTOR' S SIGNATURE
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HOMEOWNER'S SIGNATURE
STATE OF FLORIDA
COUNTY OF
~~~~FO~O~A~U'~
The foregoing instrument was acknowledged
before me this _ day of , 20_, by
, who is personally
known to me or who has produced
as identification.
The foregoing in~trument w~now!~9ßed
befprf.1;¡ th~ day of \j wtt 2rJl!J, by
tAJUf-t; mtL., who is personally
t':6known to m~ ~~ W}19JJ.a~ w:oduc~d .. .
tí /)D~ 5 - tt-' I· ff'58 U as Identl hon.
(Seal)
Commjssion No.
(Seal)
Signature of Notary
Type or Print Natne of Notary
Commission No.
Cm I revised 1/17/2007
No Faxed Copies, Only Original Notarized Copy will be accepted.
DA TE:
RECEIVED
JUN 0..1 2001
PERMITTING
St. Lucie County, FL
PERMIT NUMBER n~- 0 I --.- t (~f .
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
ADDRESS
39
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OWNER'S PHONE NUMBER
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OWNER'S SIGNATURE