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HomeMy WebLinkAboutPower AffidavitBOARD OF COUNTY COMMISSIONERS Electrical Affidavit Date 1'a caro a� [ ©. PLANNING & DEVELOPMENT SERVICES DEPARTMENT Building and Code Regulation Division Parcel ID # :3q (,"L q Address 1214 -- �- e , F- 5 C/ S �� Permit # .2 1>6 3 - QYl 7 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 at the boat dock Renting or leasing boat dock I fully understand that if the conditions of this affidavit is found in off to the dock without notice. Print wner's ame STATE OF FLORIDA, COUNTY OF may be shut SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR ONLINE NOTORIZATION THIS ;�--5 DAY OF _� �, 9 — 20 QL ,— NAME OF PERSON MAKING STATEMENT PERSONALLY KNOWN .!/ OR PRODUCED IDENTIFICATION Website: WWW.Stiucieco.gov 2300 Virginia Avenue - Fart Pierce, FL. 34982-5652 Phone (772) 462-1553 FAX (772) 462-1578