WAIVER OF HURRICANE PROTECTION AFFIDAVIT
Town of Fort Myers Beach May 29, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
Permit No.
Project Address
Job Description ________________
Name of Owner Phone ________________________
Contractor: License No.
Company Name: Phone
Contractor Address:
Contact Person: Email:
I understand that the Shutter Products that I am purchasing and having installed on my
home are not Hurricane rated Shutters and do not meet the test protocol for the Florida
Building Code.
Under penalties of perjury, I declare that I have read the foregoing waiver of the Hurricane
Protection Affidavit and the facts stated in it are true.
I, _____ (Property Owner), hereby certify that
_______________________________________ is my authorized agent/representative of the property
described herein. All answers to the questions in this registration and any supplementary
information attached to and made part of this registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
