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-BOARD-OF SERVICES DEPARTMENT
COUNTY
COMMISSIONERS . Building and'Code:Regulation
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Elevation Affidavit
-Date
Property Address: a jl�; ' (�.i�: tbl� a,,J
Permit # Flood Zone
'The non -habitable./ non-residential'bi ild ag (aecessory structure). cannot .be
converted to,a.habitable dwelling unit unless it is modified -With a building pennit.
to comply with the relevant elevation requirement:
Print Owner's Name Signa. e Of.Own&
-STATE. OF FLOkDA
CO. - NTY 01F I'11► nd 1 .
The foregoing instrument * ac owledged before me. this Zw da : of .._ e �"t ?rrt , 24.: i
b personally known o.me or who has produced
As identification.
MELODYL.DAUGHERTY Signature of Notary Public ; �o. • • . � ; •
Commission#. GG 313218
6 Expires July 17, 2023
FQ,Ft°� Bonded Thru Troy Fain.Insurance 800.385-7019 ..
Commission Nuniber
Webslts: em s8ucleco:cov
2300 Virginia Avenue - Fort. Pierce; FL. 34982-8652
. Phone (7.72) 462-1653• FAX (772) 462-1578