HomeMy WebLinkAboutGuest house affidavt ' YYY
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
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2300 VIRGINIA AVE
FORT PIERCE,FL 34982
772462-1553
GUEST HOUSE AFFIDAVIT i
I hereby affirm that Building Permit# I is to be issued for a dcnce
math-attaeh e.The gi ouse will not be used for rental purposes, seasonally
or annually,under any circumstances.�-
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Print Owner's Name Signature of Ow&r
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STATE OF FLORIDA
COUNTY OF Sl. I. uC,k£.
The foregoin instrument was acknowledged before me this 2� day of ;"C�1 �'i- 20�1
by_DC1 41'k C. James T k Q r4 t).SC11 personally known tome(� or who has produced
10 r; G�� G�t i�1fv�5 t Ce.y"5 C . as identification, i
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Signature N 1�v
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Commission Number B ORrI
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GG 93470 s Q W
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SLCPDSD Revised 08/24/2010
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