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HomeMy WebLinkAboutElectrical AffidavitSu o --- Electrical Affidavit Date & Ao = Parcel ID # T LUCRE, WORKS Address ,��� G©e4l000 �T�/t/Cf G'lZ' rF�I—ge,ry� l Permit # I have requested to install an additional electric 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. Print Owner's Name Signature of Owner STATE OF FLORIDA, COUNTY OF T,, D: o,, A: ✓, 2 SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR ONLINE NOTORIZATION THIS / DAY OF M ^ r L K 20 "Z. -t - NAME OF PERSON MAKING STATEMENT PERSONALLY KNOWN OR PRODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED F-I d r'- Q p r : ✓ L. G = A;s -= — --- C__ �_P )3 ,E N c -S/ 7` -- SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY 0 -/ 9 COMMISSION NUMBER (SEAL) :Yot�siv"e�e�; BEN C SALTZ Notary Public • State of Florida Commission # HH 146049 My Comm. Expires jul 9, 2025 Bonded through National Notary Assn. PLANNING A DEVEL®PMENT SERVICES I BUILDING DIVISION 1"2300 Virginia Avenue I Fort Pierce, FL 34982 U (772) 467 - 1585 2 (772) 462 - 1428 40 (772) 462 -1581 -e www.stlucieco.gov