C:\Users\JascombD\Documents\Forms & Documents\Non-Inspected-Accessory-Affidavit.docx Established January 2016 Revised: 9/12/2019
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Community
Development
Zoning Division
18400
Murdock Circle,
Port
Charlotte,
FL
33948-1094
Phone: 941.743.1964 Fax: 941.
743.1598
www.CharlotteCountyFL.gov
“To exceed expectations in the delivery of public services.”
Affidavit for Accessory
Structures
Not Requiring a Zoning Inspection
Applicant's Name: ______________________________________
Street Address: _____________________________
City, State, ZIP: ____________________________
Note: all site plans, drawings or sketches must be drawn to scale and shall indicate all buildings, easements
and setbacks. Real Estate Services may be contacted at 941.764.5588 for information regarding easements.
I, the
undersigned applicant,
being first duly sworn,
depose
and say that
I
am
the owner,
attorney,
attorney-in-fact, agent, contractor,
lessee or
representative
of the owners of the majority of the
property
described
and which
is
the
subject
matter
of the
proposed application;
that all answers to the questions
in this
application,
and all site plans, sketches,
data
and other
supplementary matters
attached
to and
made
a part of the
application
are honest and true to the
best
of my
knowledge
and
belief.
Any costs, expenses, liens, lawsuits and liabilities that arise from the issuance of
this permit regarding
building location
are
the sole responsibility of the
contractor
and
property
owner. It
is
also understood that
the County does not verify the final location of structures or their setbacks and that all structures must
be compliant
with
required setback regulations and that all permit and license requirements apply.
Additionally, the structure covered by this affidavit shall be compliant with all county codes and regulations.
If non-compliance is discovered, a code enforcement case may be opened and pursued.
PLEASE CHECK THE APPLICABLE RESIDENTIAL ACCESSORY STRUCTURE BELOW:
State of , County of
The
foregoing
instrument was
acknowledged before
me this
day
of , _____________________________
(M
o
nth) (
Ye
ar)
by who
is
personally known to
me
or
has
produced
as
identification
and
□ who did / □ did not take an
oath.
Printed Name
of Notary
S
i
g
natur
e
of
A
ppli
ca
n
t
(
o
r
C
o
ntr
a
c
tor)
Signature of Notary
Contractor
License
Number
Commission
Number
Area
Code
Phone
Numb
e
r
(Return
completed
form to the Permitting
Office after recording with the Clerk of Court)
Boat Dock (Replacement ONLY)
Boat Lift (Natural Body of Water or
Replacement ONLY)
Canopy/Boat Canopy
Carport in Mobile Home Park
Fence
Non-Structural Slab
Shed Under Carport
This Space Reserved for Recording
