HomeMy WebLinkAboutELECTRICAL AFFIDAVITL`L: L�! ALL
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Electrical Affidavit
Date-- a
Parcel ID #
Address v
Permit #
I have requested to install an additional electric service/meter at the above -named property.
By signing this affidavit, I filly 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
1 fully understand that if the condition of this affidavit is broken without consent, power could
be shut off to the building without notice.
Print Owne s ame Sig ture of Owner
STATE OF FLORIDA. COUNTY oFy"Gf e T^
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEF RE ME OF PHYSICAL PRESENCE
ONLINE NOTORIZATION THIS � DAY OF 20
NAME OF PERSON MAKINUST TEMENT
PERSONALLY KNOWN OR PRODUCED IDENTIFICATION
TYPE OF IDENTIFICATION PRODUCED
�tR
SNiN TIJRF OF NOTA PUBLIC TYPE OR PRINT NOTARY
G63�_Of,_5COMMISSION NUMBER (SEAQ RE
lrc Stale of Flontl.l Butterileldaeron GG ]07De5
1412023
PLANNING & DEVELOPMENT SERVICES BUILDING DIVISION
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