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Electrical Af
davit
Date - J a
Parcel 1D# 311- Coo'5—0004-00 a
Address q Ile
Permit# all D-p6K-
I have requested to install an additional cleciric 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.
PAnit Owner's Nam. Signature of Owner
STATE OF FLOWDA,COUNTY OF twt-
SWORN TO(OR AFFIRMED)AND SUBSCRIBED BEFO ME OF PHYSICAL PRESENCE OR
ONLINE NOTORIZA77ON TFUS DAY OF 20 A,2 . ,
NAME OF PERSON MAKING ST NT
PERSONALLY KNOWN OR PRODUCED IDENTIFICATION
TYPE OP IDENTIFICATION RODUC D—
Mits5 v4!-te
+4A :$anirnission GG 302065
C OR PRINT.NOTARY
005COM WSSION NUMBER (SEAL) #0'4 "wry PubAC State of Florida
L Butterfield
Va IT,
�p foiz 02/14/2022
PLANNING& DEVELOPMENT SERVICES(BUILDING DIVISION
Vin2inia Avenue I Fort Piero,FL 34982 `+(772)467-1585 (772)462-1428 10(772)462-1581 awmv;e.stlucieco.go4