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HomeMy WebLinkAboutAffadavitBOARD OF COUNTY COMMISSIONERS Electrical Affidavit Date Parce PermitAddress C(ob PLANNING & DEVELOPMENT SERVICES DEPARTMENT 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 Print Owner's Name STATE OF FLORIDA, COUNTY OF Signature o Owner SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR ONLINE NOTORI7ATION THIS 3 � DAY OF �` _ 2©_10_ NAME OF PERSON MAKING STATEMENT PERSONALLY KNOWN A, OR PRODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED 4GA%CiFT �PUBfI� U COMMISSION NUMBER TYPE OR PRINT NOTARY a" - t1 R Karen Des4erg NOTARY PIA111C -+STATE OF FLORIDA Comm# GGO 5301 ti Expires 3121/2021 Website: wwwr.stlucieco,,g 230D Virginia Avenue -Fort Pierce, FL. 34982-5652 Phone (772) 462-1553 FAX (772) 462-1578