1600 SELVA MARINA DR - TENT (2) AFFIDAVIT FOR ELECTRICAL WORK IN OR AROUND A TENT
B - - .
(permit number)
To: City of Jacksonville, Building Inspection Division
214 N. Hogan Street,Second Floor
Jacksonville, FL 32202
From: ` .,00,- v -aG- t tt Co u,..1nt.,-j c1_,4,731 ,dC.
lyra' 5c2uA wtfta-+*Jw -42.
Aft-rc m - B ckt; -R.- 3 2.2.33 '
Before me the undersigned,personally appeared Kd?l?r A.Srawt�., >r-- 6/004.444-L. ur p /
(name of owner)
Who being first duly sworn deposes and says:
1. That the tent to be erected at I(;Cab 5au,4 vi .w4 DA.
will not have any electric lighting or electric service. This includes electric
running off of a generator.
2. If an electric service or generator is used for lighting or electric power it will
be installed in accordance with the National Electric Code.
3. All electric work will be performed by a licensed electrical contractor and
permitted through the Building Inspection Division.
I understand that if any electric service is used that has not been permitted that I am subject
to the City of Jacksonville revoking my tent permit and ordering the premises immediately
vacated.
Signed: Date: g •ZZ• l8
Print Name: {jor A. 5tn,..,t= ),L
Before me this 1Z day of Ati1.rcST in the county of Duval,State of Florida,
has personally appearedb� Pr. � '�
herein by himself/herself and affirms that all statements and declarations herein are true and
accurate.
Notary Public at Larg State of - ,County of'p`-t✓�I
Personally Known V or Produced Identification
ID Type
;h
ikv*, COLLEEN VASTOLA
.4. MY COMMISSION#GG077999
EXPIRES February 28,2021