HomeMy WebLinkAboutElectrical Affidavit ;i PLANNING & DEVELOPMENT
BOARD OF G SERVICES DEPARTMENT
COUNTY COUNTY
COMMISSIONERS . R I D A Building and Code Regulation
Division
Electrical Affidavit .
Date L !' R'L9I
Parcel IID #
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Address SO;b S s t PrL /?3ff,�r L� `3 y 5$ Z
Permit# C�
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 in violation
of the LDC
• Renting or leasing any portion of the accessory structure in violation of the LDC
• Converting accessory structure into additional occupied or living space in violation
of the LDC
I fully understand that if the condition of this affidavit is broken without consent, power
could be shut off to-the-building without notice.
Print Owner's Name Si of Owner
STATE OF FLORIDA,COUNTY OF `off CA—L—
SW2rTO(OR AFFIRMED)AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR
2i, ONLINE NOTORIZATION THIS Z It2 DAY OF_�61 20C24Z
NAME OF PERSON MAKING STATEMENT
PERSONALLY KNOWN OR PRODUCED IDENTIFICATION
TYPE OF IDENTIFICATION PRODUCED ( L/
SI/I GNA OF N ARY PUBLIC TYPE OR PRINT ARY
y701( OMMISSIONNUMBER o����"'8==FloridaN
VAUGHN
" `V •(SEA `,?it�'ra�
da-Notary Public-' n #GG 270079
i9/Fp��l\O�' ssion Expiresr 22, 2022
Website:www.stlucieco.gov
2300 Virginia Avenue-Fort Pierce,FL. 34982-5652
Phone(772)462-1553 FAX(772)462-1578