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� ,� J �(1(i j r(�i I;t 1 <br /> c,8/�:3!�f i� 11:�a Fn?� , . <br /> PE 1T qppL,ICATION <br /> s <br /> UTILIT�ES LCICATE C�FDFIRl�4 TIUN NUMBER: i <br /> PR VZDE SKETCH IN 7'HI�ARE,A, IF mQ MOPIAL SPACE xS RE+�UIRED, ATTACN TC� TMI� � <br /> AP,l.ZCATZON. � <br /> �� <br /> . :; <br /> � <br /> � <br /> � 3� <br /> ) 4� W <br /> t � r� !1 <br /> v <br /> ��`�7I ��� �/ <br /> - -+' - �"'i OEI� EXP�ll1S l Ea�U <br /> � ,,�, � �'dG6 0� t`�'iEYEM.�U1' ; <br /> � �:, ' <br /> . ..._. _._-, — .,_ �r�'T�.t,C.i: �tT�ttt�1 p�;�3c.t��iGt4�`o�u��'�— : <br /> ! :� <br /> AFFlC3AttIT: A�rpllcaGon ls hereby m�de oa obtain a p to do�iroric and irutallations es Ind{caaed. I teRlfy thdt dll FtSregoirs� <br /> inf�rrr�atlon Is accurate�nd that ali woric wtl(comply wltil all dpplic�ble cOdes� I understand ches�codes shail rak,e preo�denca aver ell <br /> apprc�+ed tofiStruCtion documents,arn1►ssuence of tt�is p rmlt is veri8cation that F wtf!notlfy ihe property owner af Flar4da Lsen l,aw <br /> req.,�.5.?23, <br /> lssua�oe of this permlt do�not ensur�com (lanoe wlth deed restrlct�iorts and I unriecstand that adcllt#ana!deed +E <br /> r+�stMctto rn�Y�PPh'�o this praperty. , <br /> A!! ' rk sliel0 cotr�pt�w!!!►the turrent Flotl Bulidlrt�Cade,PuWtc vltorks[}aaign l+oene�!+�nd FOC)T Design �, <br /> 8tettd�t+�Is(if app!"rcebfe). (�Pubilc V�lc�rk� as1�n Mar�ual online link:www.cl.¢ephyrhlits.fl.usJPublic_waric�.asp7 ;; <br /> A PLICATIQN I5 YOIQ UNLESS SIGI�ED H PR4PER IDENTFFICATIdN ANO 1NTfNESS�D 8Y A PERM�"T' � <br /> TECt�lt�I N aR NOTARY PUBLIC. <br /> !, N E: Tbe Clty of Zs�bylfilll�ts nat�+aspas�lble r maln�aneQ or rep�irs af+drive�rays. Orhreway�c eheit�ot alLor j . <br /> i inbetfidre�r{th enciedr►Q s rtnwatet bro�tment gnd j or vamre�►+��ce. <br /> � PROP lY : By 5igning khis appllcatlon: aett(fy th�t I have read�nd undersC�nd the owner/bullder d�closure .. <br /> stafi� snt.��������(please mitsal} i <br /> , <br /> � : <br /> ', AAi�" t�t Prtnt Narrre ,0.ppit n �awre ae ;� <br /> ' � 0�c�8 �_ . <br /> ¢ermi Techr�cian 5lqnaazre (or) ry 9�gn re Da� .� <br /> r� <br /> 1�P#IcanL Is�ersanatiy kfaown tfl Rt�or pr�duced 8s kd 14A'�tlRtlll M�O�lN$OIaE <br /> type of identification} ;`' •O= MY CEiiVIriAi88tON�t�Z36573 <br /> F•XPtR�S JLnr 0�'.Z019 ,{ <br /> Pa�e 2 of 3 .+trisan�t�e� � a,o.sa� �° <br />