HomeMy WebLinkAboutFOUNDATION ONLY AFFIDAVITPlanning 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. I210-03>Z5
I Lv AFt 1(- 1,,IORM3 t� 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
permitting. Please be a(
future strActurelccov
of the engineered drawing submitted at the time of
nce
Contractor/Owner Builder
mum required setbacks must be met for any
the applicable zoning district.
STATE OF FLORIDA
COUNTY OF1nk �74¢
The forgoing Instrument was acknowledged before me
This 3\ day of GcC ejbo/ 20 -Lby
(Name of erson acknowledggiing)
- ,-Q Q a
(Signature of No ary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced Ly\VWSA .� RA
Commission No. C",GI IOi`1-%(Sea[)
„Re1° Angela Schinske
COMEINIM MAIM
EXPIRM May 4. 2021
..3`. Bonus Ti1ru Aaron PJotary 'I
SCANNED
BY
St. Lucie County
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.
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.
Contractor/Owner Builder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
This _ day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public -State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
SCANNED
BY
St. Lucie County