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Building&Code Regulation Division 2300 Virginia Avenue
i
ICOUNTY -A&. Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443 RECEIVE0
ROOF INSPECTION AFFIDAVIT DEc 2 7 2016
PERMITTING
St, Lucie county, FL
Re: Permit#X//-0Wg"
-1 la'A7 0'0 j^ //0-A�'�2�--I) , licensed as a(n)Contractor*/Engineer/Architect
(Please print name 8tifircle license type) *FS468 Building Inspector
*Generoljabilding,Residential or Roofing Contractor or any individual certified under 468 F.S.to make such an inspection.
On or about "0 1 did personally inspect the roof deck nailing
(Date)
work at: 4, -o �/ 7 9
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most str* ent).
'
S i g n a t&,-- an e
dS' dl License #
STATE OF FLOADJ
COUNTY OF -tjCtt-,
A Aeff�/1'2
SwoWro and b 'b d before ffie this. day of 201
by A Who is personally known to me or who has produced
scrt e as identification.
otary Pu i e Fl areq KAREN S. NIELSEN
Sig Y: AA Commission# FF 115637
C mission Expires
�i o= tWe 12, 2018
Commission Number:
En 01/19/2011
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY
FILE # 4261221 OR BOOK 3946 PAGE 985 , Recorded 12/27/2016 09:18 :07 AM
STATE OF FLORIIA
SL LUCIE COUNTY
THIS IS TO CERTIFY THAT THIS IS A
E C E 6 VE® TRUE ANO CORRECT OPY OF THE
Id
DEC 2 7 2016 PH E.
Depu Work
PERMITTING (��(' 2 7 216
Pilemlitil�: St. Lucie County, FL L
%/ NOTICE QF COMMMMW
The undamigned bm*given notice that impzovement will be made to certain real property,and in aocordenoe with Chapter 713,
Plaids statutes the following information is provided in the Notice of conunatoement.
1.DESCRIPTION OF PROPERTY(Legal description and stmt mkh=s)T MUO NUMBER: ZdV,& 9W:Z 029 7
SU1111 N L TRACTir LDG UNIT
2.GENERAL DESCRlMON OF IIVIPRO
741,2E 717
3.OWNER INFORMATION: LN
b. intcmK in property
d.Name and address of fee side titleholder Of other than owner
4.CONT'RACTOR'S NAME.,ADDRESS AND PHONE NUMBM
5.SURETY'S NAME,ADDRESS AND PHONE NUMBER AND BOND AMOUNT
6.LENDER'S NAME,ADDRffiS AND PHONE NUMBER:
7.Pmm witia the State of Florida designated by Owner upon whom oodm or other documents may be served to provided by
Section 713.13(Ixa)7.,Fhruda Staft&j.
NAUZ,ADDRTM AND PHONE N1Mt3R:
8.In addition to himself or banK Owner daigaatoa the foLmiug to tec dve a copy of the Limioes Notice as provided in Section
713.13(1)(b),Plorida Stouter:
NAM$AMR=AND PHONE NL%Mn:
9.Expiration lope of notice of comrnanconment(the expiration date is 1 year from the date of recording unless a diffaent due is
=pied) - - -20_
WARNING TO OW URz-ANY PAYMP M MADE 13Y IM O W M AFM Mffl EUMA=N DP nffl t =OF Co rr
ARECON tMPROFR+A PLAYA Tt3 3' r+Tlyr r+r'1JnN 71]_13_ nnmA rrATUTEL Abm AN macn T
Signator of Owner Our Ptfat Name nod Pe ovidn 's Tuid"moe
Owner's Audmiaad Omoer/Dlrector/ParbmftA+nger
Sate of Florida
County of Sar•Ly s.i t
The foregoing inrtru hent was wAmwlodged before ran this R- day of b,-L,r- ?A�
By 1-'\j tot r e\ ;
(Name of (lope of autboriry...e.g.Owna,ofllca,Watee,attamty in fact)
F a -,r 0--)nA r
(Name party on behalf of whom imurtment wan executed) Personally Known__or pmduoed the following type of ID:
j%-NC% Gov�w5 .3 0, ►tYc "A"t"kE
� oMrrisss�a oc soars
(P&W Nude of Notary Public) (Signature of N Public} fGNEW
• R 2ole
�rr�a
4
Under penalties of perjury,I dalue*a I have read the foregoing and that the facts in ft are true m um=0Cn?lmWymmvWmW
belief(section 92.525,Florida Statuses).
Igmsture(r)of s)or 081ar who atgned above:
13y. 8y