HomeMy WebLinkAboutAFFIDAVITST. LUCIE COUNTY
PUBLIC WORKS DEPARTMENT
CODE COMPLIANCE DIVISION
2300 VIRGINIA AVENUE, FT. PIERCE, FL 34982
AFFIDAVIT
Aluminum Structures Being Placed on SCANNED
Existing Concrete Slab BY
% St. Lucie County
Permit # a%01- Z QgC1 Site Address: 3l 3 �o o b n Ct cc /C
Contractor: Q IL) J , A o Homeowner:
All footings and slabs being used for the re -construction of structures must meet the current
specifications of the engineer of record or current design manual being used. If a 4" concrete slab is approved by
an engineer or design manual, signatures are required as stated below.
I the Contractor have verified that the existing concrete slab is a minimum 4" thick and is in fair
condition to withstand the weight of the aluminum structure. By signing this affidavit, the contractor and
homeowner release St Lucie County of any liability or responsibility related to this project
I the owner have been made aware of this and have full knowledge and understanding of the above information.
CONTRACTOR'S NAME
C NTRACTOR'S SIG"A URE DATE
�fn0. LI(DCmj-o
NOTARY PUBLIC, STATE OF FL.
ASZQE.QNTRACTOR�,
GUSON
PRODUC D ' 2 ENA M. WOODS
TYPE MYCOMMISSION#DD566120
/t07R6 MAFIRFB: June 2u.mlu
Revisal 5/17MS (407)N"133 F1.1de No" e.Ncamn
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NOTARY PUBLIC, STATE OF FL.
AS TO OWNER
PERSONALLY KNOW "'"'i""•; Ellen L Roulette
• �
PRODUCED s5i0N# DD953192 EXPIRES
T - September
TYPE #, Se ' mber 25, 2007
DiMUTROY FAIN INSURANCE, WC