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x Building and Code Regulation Division
i
CUUNTY
2300 Virginia Avenue, Fort Pierce FL 34982
''' Phone: (772) 462-1553 Fax: (772)462-1578
Foundation only affidavit for residential accessory structures
Permit No. I`ll l • 0301
understand that I am proceeding with- the
foundation at my own risk. I understand that there is no assurance that my permit
for the entire structure will be granted and that I accept full responsibility for.any
changes that are required in the design including but not limited to elevated 18
inches above the crown'of the road or above flood elevation. The foundation must
meet the requirements of the engineered drawing submitted at the time of
permitting. Please be advised minimum required setbacks. must be met for any
future structure ' accordance with the applicable zoning district.
C�ractor Owner Builder
STATE OF FLORIDA ` \\
COUNTY OF
The forgoing instrument was acknowledged before me
This day of tQ6,( .20JI by
c a C .QL—
(Nafye of person ackn wledging)
(Signature of NotaryPubli -State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal) .
L
ASHAHNAiNGRA�
public-State of Florida Notary
WRY Comm.Expires Dec 20,
Commisston#FF 177289
of��° Bonded through N
ational Notary Assn.