HomeMy WebLinkAboutMISC LETTER - AFFIDAVIT - STURCTURE ON CONCRETE SLABST. LUCIE COUNTY
PUBLIC WORKS DEPARTMENT
CODE COMPLIANCE DIVISION
2300 VIRGINIA AVENUE, FT. PIERCE, FL 34982
AFFIDAVIT SC BY ED
Aluminum Structures Being Placed on St. Lucie County
Existing Concrete Slab
Permit # b((7q — Div 13 Site Address: / Ea / G D /" / if / /�
Contractor: chop,( �'_@eiY 1 t Homeowner:_ /1_ S% a T T L c Pt /R/,
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 / Owner builder have verified that the existing concrete slab is a minimum 4" thick and
is in fair condition to withstand the weight and up lift of the aluminum structure. By signing this affidavit, the
contractor or owner builder release St Lucie County of any liability or responsibility related to this project
I the applicant am aware of this and have full knowledge and understanding of the above information.
J`��c aCl �r�rt,P�r-lu
CONTRACTOR'S NAME
CNT
Cl SIGI FP TURD
?•�;n'r'oga.,Melissa F.Quinones
Ca1nMLei0m##DDIM370
:mot a�?Hxpim March 21, 2MG
OFil.` Bonded Thar
Atlantic BondLa Co qk=
NOTARY PUBLIC, STATE OF FL.
AS TO CONTRACTOR
PERSONALLY KNOWN_
PRODUCED ID
TYPE'
OWNER BUILDER'S NAME
OWNER BUILDER'S SIGNATURE DATE
NOTARY PUBLIC, STATE OF FL.
AS TO OWNER
PERSONALLY KNOWN
PRODUCED ID
TYPE
RsK. il $25,05