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DA TE:
RECEIVED
APR 2 5 2007
PERMIT NUMBER {25tJ~ - / y il
p c:: ¡:~ fit I TT I N G
St LLcie County, FL
ATTENTION: RAY W AZNY, BUILDING OFFICIAL
I ~O ~ &tþO»
~/
, (OWNERlBUILDER),
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
OWNER'S PHONE NUMBER 77~
'1.esidential Roof D y-In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
Building Permit # tJ£o;¿ - /96/
Owner's Name ~p ~ ¿£)¡Þo/()
Owner'sAddress 1~o Þk/l~: Æ &JßI Joe¡.¿ /-l 31952
)
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 personally
known to me or who has produced
as identification.
Signature of Notary
Type or Print Name of Notary
Commission No.
(Seal)
No Faxed Copies,
Cml revised 1/17/2007
'/1
OMEOWNER'S SIGNATURE
STATE OF FL~i-u /, r,J'J
COUNTY OF .. L-,1 L
Commission No.