HomeMy WebLinkAboutElectrical Affidavit BOARD OF ��o ��IC Q[ ,� PLANNING
SERVICES CES DEPARTMENT DEVELOPMENT
COUNTY O
COMMISSIONERS I s Building and Code Regulation
Division
Electrical ffida it
Date f ` o O
Parcel ID# 39ts0' a - O1So -06D
Address l O IC JEk ORk N. Fa-r PTE,uE, a 3q Wl
Permit# SLG 00D S'0083
I have requested to install an additional electric service/meter at the above named property. By
signing this affidavit I fully agree that the additional electrical service/meter does not allow for
the following:
•Operation of a business venture or entity within the accessory structure
•Renting or leasing any portion of the accessory structure
•Converting accessory structure into additional occupied or living space
I fully understand that if the conditions of this affidavit is found in violation,power may be shut
off to the building without notice.
'��'h. �)�i.(,h � �1•t7 is S ��i�'�.�� �/�`
Print Owner's Name Signature of Owner
STATE OF FLORIDA,COUNTY OF J&; :g;M ZVC..!Z
S WORN TO(OR AFFIRMED)AND SUBSCRIBED BEFORE ME OF ` PHYSI PRESENCE O
ONLINE NOTORIZATION THIS ]�_$.l DAY 20e,
NAME OF PERSON MAKING STATEMENT TT
PERSONALLY KNOWN OR PRODUCED IDENTIFICATION r/DC
TYPE OF IDENTIFICATION PRODUCED 7'—jX �(mil/ ,r�[/•� 0 0 3
Vn►r,ARi57,n TY�C,�
SIGNATURE OF NOT R B C TYPE OR PRINT NOTARY
i►r�� EMMA CHMSTINE LYNCH
i Notary Public-State of Florida
;® Commission M GG 962663
0f MI)AIfdAi.itt6Reb 26,2024
(SEAL)
Website.www.stluoeco.gov
2300 Virginia Avenue-Fort Pierce,FL. 34982-5652
Phone(772)462-1553 FAX(772)462-1578
t r 1