Fillable Affidavit of Compliance for Protective Barricade Inspection (Hillsborough County)

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Affidavit of Compliance for Protective Barricade Inspection (Hillsborough County)

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The Affidavit of Compliance for Protective Barricade Inspection (Hillsborough County) form is 1 page long and contains:

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  • 13 other fields

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File type: PDF

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1 of 1 07/2020
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Affidavit of Compliance
for
Protective Barricade Inspection
Pursuant to Arcle 4.01.14.A.6 of the Hillsborough County Land Development Code (LDC), the Natural Resources
permit shall not be issued unl protecve barricades for the preservaon of trees and other vegetaon have
been installed. This Adavit of Compliance shall serve as conrmaon that protecve barricades for the project
have been installed and accepted by the Engineer of Record in conformance with the required locaons and
specicaons as idened on the project Construcon Plans approved by Hillsborough County.
Project Name
Engineer of Record Name (print)
Engineer of Record Signature
Signature Date
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Project Address or Folio #
Engineer of Record Phone #
Engineer of Record Seal
OR
The foregoing instrument was acknowledged before me by means of
o
physical presence or
o
online notarizaon, this
________ day of __________________________________ , _________________ , by___________________________________________________ .
(day) (month) (year) (name of person acknowledging)
o
Personally Known OR
o
Produced Idencaon
Type of Idencaon Produced
(Notary Seal)
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
(Commission Number) (Expiraon Date)
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Affidavit of Compliance for Protective Barricade Inspection (Hillsborough County)

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Completed 11 February 2021

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