HomeMy WebLinkAboutGUEST HOUSE AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION RFcFrVI-o
2300 VIRGINIA AVE OCT,2 6
FORT PIERCE, FL 34982 per ttin
10Jg
st 4UCQC a tyenr
GUEST HOUSE AFFIDAVIT
I hereby affirm that Building Permit # 190
is to be issued for a guest house whic724��
or annually, under any circumstances
I..
�,Zeitldf- k(0110
Print Owner's Name
STATE OF FLORIDA 1
COUNTY OF
Signature of Owner
Z 7.!�'
SCANNED
at Lucie coup
seasonally
going instrument was acknowledged before me this a� day of C 20
by ti; o personally known to me or who has produced
as identification.
of Notary
Commission Number
Notary Stamp
L.ASHAHNA INGRAM
M
`46�1., Notary Public - State of Florida
aMy Comm. Expires Dec 20, 2016
o` Commission # FF 177299
�'7,,%q , ;°`' Bonded MINOR National Notary Assn.
SLCPDSD Revised 08/24/2010