HomeMy WebLinkAboutFOUNDATION AFFIDAVIT - RESIDENTIAL STRUCTURES:rvE® Planning and Development Services
1018 Building and Code Regulation Division
)fo'4n vent 2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED
BY
St Lucie County
Foundation only affidavit for residential accessory structures
Permit NO. /491 -5 r 7
T'
i
I L- lbf9N understand that I am proceeding with the
foundation at my own risk. I understand that there is no assurance that my permit
for the entire structure will be granted and that I accept full responsibility for any
changes that are required in the design including but not limited to .elevated 18
inches above the crown of the road or above flood elevation. The foundation must
meet the requirements of the engineered drawing submitted
permitting. Please be advised minimum required setbacks must
fiture structure in accordance with the applicable zoning district.
Contractor/Owner Builder
STATE OF FLORIDA
COUNTY OF uua
The forgoing instrument was acknowledged before me
This day of N oy Lt=� , 2010 by
(Name of person acknowledgin
(Signature of Notary Public -State of Florida)
i
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. G&17 0(Seal)
ELLEN VAUGHN
W
iState of Florida -Notary Public
Commission # GG 270079
My Commission Expires
•� °f_� : oeteber 22 2922,
at the time of
be met for any