PASCO COUNTY
CENTRAL PERMITTING DIVISION

AFFIDAVIT OF LOT GRADING
FINISHED FLOOR ELEVATION COMPLIANCE

Building Permit No. _____________________

Parcel Identification No.: ___ ___ ___ _____ _____ _____
   S T R SUB BLK LOT

Address: _________________________________________________________________________

I, _____________________________________________ affirm that as of______________________,
(name of owner/builder) (date)

I have reviewed both the constructed lot and the as-built survey and can affirm that this lot has been graded and elevated in accordance with the approved plan except for the following deviations:

_________________________________________________________________________

_________________________________________________________________________

I understand that any deviations listed above will require review and approval from the County prior to scheduling the final inspection, and that a copy of this will be attached to the Building Permit records.
_____________________
Date

___________________________________________________
Signature (License Holder)

___________________________________________________
Name & License Number

___________________________________________________
Company

___________________________________________________
Person to contact if there is a problem with this submittal.

___________________________________________________
Company Address

___________________________________________________
Telephone

FOR COUNTY USE ONLY

Reviewed By: ____________________________________

Approved By: _____________________________________

Date _________________________