HomeMy WebLinkAboutelectrical affidavitFOX crown - 5800245 dish - MIMIA00098A
app - 551638
- , "` ST. LUCIE WORKS
Electrica Affidavit
Date 09 22/2021
ParcellD1# 1431-211-0001-000-2
Address 5041 St. Lucie Blvd.
Permit #
I have re uested to install an additional electric service/meter at the above named property. By
signing't is 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
I fully un erstand that if the conditions of this affidavit is found in violation, power may be shut
off to th0 building without notice.
(_7es iCa -Fmit
Print Ow er's Name
STATE OF FLoRIDA, COUNTY OF
Si ature of Owner
SWORN TO OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF _",1 t1 12t' z P�YSIC9I_PRESENCE OR
ONLINE NIJ ORIZATION THIS �'2A-A- DAY OF 20 2�
NAME OF PI RSON MAKING STATEMENT
PERSONALLY' KNOWN / ` _ OR PRODUCED IDENTIFICATION
TYPE OF DE
TIFICATI`OONJ PRODUCED_
SIG SIGNATURE DF NOTARY GPUBLIC
COMMISSION NUMBER
TYPE OR PRINT NOTARY
ON 13,1
SAL),' My Comm. Expires
June 6, 2023 ;
No. GG342460 ;
PLANNII & DEVELOPMENT SERVICES I BUILDING DIVISION
1 2300 Vikg nia Avenue I Fort Pierce, FL 34982 'k- (772) 467 - 1553 22 (772) 462 - 1428 10 (772) 462 - 1578 Q www.stlucieco.gov