HomeMy WebLinkAboutELECTRICAL AFFIDAVITc v uct Er-
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Electrical Affidavit
Date_ 2 b22 /22
ST.LUCE
Parcel ID # Z3oci - 341 - 6op" -000 -a
Address i"71 eA (4 R el ce
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.
e er
Print Owner's Name
STATE OF FLORIDA, COUNTY OF .%, fir -,a
Signature of Owner
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF x PHYSICAL PRESENCE OR
ONLINE NOTORIZATION THIS ZL DAY OF YGbuc�i 20 27,
NAME OF PERSON MAKING STATEMENT
PERSONALLY KNOWN )1 OR PRODUCED IDENTIFICATION —SoSejlti 9"e ,
TYPE OF IDENTIFICATION PRODUCED
SIGNATURE OF NOTARY PUBLIC
uK o(. COMMISSION NUMBER
SI-410 .54Ug jt/'5
TYPE OR PRINT NOTARY
(SEAL)
PLANNING & DEVELOPMENT SERVICES I BUILDING DIVISION
Im 2300 Virginia Avenue I Fort Pierce, FL 34982
't► (772) 467 - 1585 r (772) 462 -1428
a, 000
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(772) 462 •• f od ryo;