HomeMy WebLinkAboutFOUNDATION ONLY AFFIDAVIT_/
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Foundation only affidavit for residential accessory structures
Permit No. 1 l')7050
I ate,(' �� 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 at the time of
permitting. Please be advised minimum required setbacks must be met for any
future structure in accordance with the applicable zoning district.
3
Contractor/Owner Builder
STATE OF FLORIDA
COUNTY OF •
The forgoing Instrument was acknowledged before me
This =day of J , 6 20k by
of
(Signature o(Notary Public- State of Florida)
Personally Known OR Produced Identification
Type of identification Produced 1�z .� .
Commission No. (Seal)
„�,, KAREN S. NIELSEN
3:° °�,%State of Florida -Notary Public
•? Commission N GG 207484
,"� �j M Commission Expires
�'?iii�•��. y June 12, 2022