HomeMy WebLinkAbout1015 S Elm Ave (2)Building & Fire Prevention Division
FIREDEPARTMENT
RESIDENTIAL, SIZED AFFIDAVIT
r I (120 SQUARE FEET OR LESS
PERMIT #: {� g "} 1 ADDRESS: I o I✓ r It4 Ave
Ili
HEREBY AFFIRM THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AND ACCURATE. THE SHED TO BE INSTALLED ON THE PROPERTY LISTED ABOVE WILL BE REQUIRED TO MEET THE
FOLLOWING: INSTALLED TO MEET ALL MANUFACTURER REQUIREMENTS, PROPERLY TIED DOWN PER MANUFACTURER
RECOMMENDATIONS, AND LOCATED ON THE PROPERTY IN ACCORDANCE WITH THE APPROVED SITE PLAN. SITE BUILT SHEDS MUST
ADHERE TO COMMON CONSTRUCTION PRACTICES. I UNDERSTAND THAT FAILURE TO PROPERLY LOCATE THE SHED IN THE APPROVED
LOCATION WILL BE A VIOLATION OF CITY CODES AND COULD RESULT IN THE SHED HAVING TO BE RELOCATED OR TAKEN DOWN AT THE
OWNER'S EXPENSE.
LICENSED CONTRACTOR
LICENSE #:
COMPANY/CONTRACTOR:
CONTRACTOR SIGNATURE:
ElHOMEOWNER (OWNER/BUILDER)
OWNER/BUILDER NAME: A �� /_ (� A•%
OWNER / BUILDER SIGNATURE:
DATE: 1-31-10
DATE: ' ! ✓ (— 1 6
"PLEASE NOTE"
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON SHEDS SIZED 120 SQUARE FEET OR
LESS. THIS AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND
WILL SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE SHED.
STATE OF FLORIDA COUNTY OF -•1; fA0 le_
Sworn to and Subscribed before me this, ?12�- day of 201 by:
Aam M le k Who is ❑ Personally Known to me or has ❑ Produced (type of
identification)
a.a��
as identification.
LL06eAP&1%
Signature of Notary Pub ffi
State of Florida
fS 'AID)
...............ANNETTE tvt BLAND
Notary Public — State of Florida
Print/Type/Stamp Name
` = Commissior = GG 17C9CO
r 61y Comm. Expires Jar 16 2C22
of Notary Public
,;'
;, cec :r. c_gr �aacra 5c:e^ Ayer.
Effective: August I, 2017