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Rl,JideJ,ltiaJ Roof Dry - J.D Affidavit
St Lucie County, Public Works Department
Code Compliance Division
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Building Perinit # OSDLf ~ <:"){)71
Owner's Name
Owner's Address
Contractor
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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 8t Lucie
County of any liability with respect to the installation of these materials.
OWNER/CONTRACTOR'S SIGNATURE
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HOMEOWNER'S SIGNATURE
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA ('t¡ J I. i . '
COUNTY OF ~ «~. Lei.
The foregoing instrument was acknowledged
before me this _ day of , 20_, by
, who is personally
known to me or who has produced
as identification.
Th..e,t,o,. rego. ing,. ~ns~m.. ent ~fknOWledged
before me, this "2.J day of' t , 202], by
Ed Itt~td (J1C1 t'Y}W (~htfjs personally
l)npwn to me or who haspro4uced
LSI Lt ' . ). ~ .. ,,;:x.j.,( cU as identification.
I ~
, Signatur of Notary l
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Signature of Notary
Type or Print Name of Notary
Type or Print Na of Notary
Commission No.
(Seal)
Commission No.
(Seal)
No Faxed Conies, 0,11" Original Notarized CO"" will be accep)'-~ë:4! PÜE.,~.IC.~TxrE OF FLORIDA
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Cml revl· sed 1/17/2007 t. ~~..,~ .....~ C~ ;;'1 ;l- ~ ~ '~~') ~-",-V-: ·'L':l-, CJ'" '8 9· 6¿ 9 4
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-"III \\~"" Jln~'Y 01, 2007
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DATE: . l-f' 3tJ oLD
PERMIT NUMBER . OS C¡ /..( - ;)(;dhj
ATTENTION: RAY WAZNY, BUILDING OFFICIAL
I ,~ ~U~DE~,
AM REQUESTING mAT THE ABOVE PERMIT NUMBER BE RENEWED. I
UNDERSTAND THAT I· MUST SCHEDULE AND PASS ALL NEEDED
INSPECTIONS FOR THIS PERMIT TO BE FINALED.
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OWNER'SPHONENUMBER 77~ ~~O ~f?c5</~
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