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BOARD OF
COUNTY
COMMISSIONERS
Elevation Affidavit
Date iaog- 02`18 3 �ao� Iq
Property Address
Permit # 19 C) Y— �n
PLANNING & DEVELOPMENT
SERVICES DEPARTMENT
Building and Code Regulation
Division
Flood Zone �<
The non -habitable / non-residential building (accessory structure) cannot be
converted to a habitable dwelling unit unless it is modified with a building permit
to comply with the relevant elevation
Print Owner's Name
STATE OF FLORID
COUNTY OF ` Z. U G\C
The foregoing instr ent was acknowledged before me this ay of 20
by -it, personally known to me or who ha4oduced
L_ U= I as identification.
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V 1 1
Signature of
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Website: www.stlucieco.gov
2300 Virginia Avenue - Fort Pierce, FL. 34982-5652
Phone (772) 462-1553 FAX (772) 462-1578