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~...esidential Roof DI.} -In Affidavit
St Lucie County, Public Works Department
Code Compliance Division
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Building Perinit #óSð8 - 03-;;)-1
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Owner's Address I D ò 9 P(oov\ K ð et ~
Contractor ¡) 1'1 oh D r- 120 ò+:~
Contractor's Address t(5"Oo µ¡Ut'"SJl)h" Dt' <~ A
Owner's Name
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. 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.
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STATEOFFLOWA~ .
COUNTY OF ~ '. . 'ðt.t¿
The foregoing i~strument tþ~owledged
before me this ~ d~~~f '. , 20-Ø, by
JTPV~ µ(~ ;¡.r¿,., who is personally
known t me or ,who has produced
F 14· 4)12. 4"6 as identification.
µ '-/00" 7'19 ~7. VI/.O
Commission No.
(Seal)
STATE OF FLO~ ~. ..
COUNTY OF ~ ·
The foregoing instrument was acknowledged
before me this ~ day O~k/ .' 2~, by
J!rpN.~ µ lu J t , who is personally
known to me or who pas produced
F./.£). De· ~ e- as identification.
(h/l ¢)'~d
~ Signature of Notary - '1J '
(J4- f) ~ \7 jJlt ~ePy
-Type or Print Name of Notary /
Commission No.
(Seal)
No Faxed Copies, Only Original Notariz~d Cop,- will be accepted.
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Cm1 revised I II 7/2007 If :-~1i"j~~lo AUDREY B. HUMPHREY ~
I fir: . :*Í MY COMMISSION It DO 633047
l'fi" ø eXPIRES: March 6 2011
o IJ.r"9'f..r,.;,,, Bonded Thru Notary Public Underwriters .
DATE: <-¡---- .".2 ç-- ~ 0 {) 1
PERMIT NUMBER . 65ð<is· 0 3 ~ 1
ATTENTION: RA Y W AZNY, BUILDING OFFICIAL
I G-l-OV't\ \ e~ to l-\-~ ~ \ ~ r. , (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 FlNALED.
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OWNER'S PHONE NUMBER ) 12- - Lffo 1- ~ \ I y-
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