Laserfiche WebLink
PERMIT APPLICATlON <br /> UTILIIIES LOCATE CONFIRMAT10Ff NUMBER: <br /> PROVIDE SI�TCH IN THIS AREA,IF ADDITiONAL SPACE IS REQUIRED,A7TACH TO TNIS <br /> APPLICATION. • <br /> 3s�3y 9�� <br /> w�- �'��Sfi�� <br /> �o,�Ue <br /> � �� � <br /> b � ��� �v� � 16• -f- <br /> �, � x � � � �uew <br /> � �� � � ��� <br /> � � <br /> � � NCca c. � � lo� "� �ou�o�� <br /> �-F�,t��S�r� Si l�W�f(/� �i�U/n!f ��iJ�W p2��Y C �9 <br /> 5" <br /> ¢� L C�a-cr� Sc�.S� <br /> L� 6 � �,,c� '� 1 <br /> r saw�rt'vcrs�AG flt�q' <br /> AFFiDAV1T': Appltratlon Ls hereby made co obtatn a�rtnh bo do wwk and I�tatlatlons as Indicabed. I aertlfy that ail foregofng <br /> Mfam�don is acarate and tl�at all woik wfll comply with all appffcabfe aodes. I wders�nd these oodes�ail tal�prea�ience over all <br /> aPP�d aons�uctfon dacurt�ents,and issvance of thls pertnR Is veiflmt�n that I wlll notlfy the property owneroF Rorida Llai law <br /> req.,F.S.713. <br /> 7T�tssuance of thls permft does rat ensure complyrroe witli deed r�estiicilons and I understand that addl�onal deed <br /> restridions may apply bo th(s property. <br /> All woHc shall eomply wFth the current Flodda Bufldinp Code,public Works De4tgn Manual and FDOT DesPgn <br /> Standerds(if applicable). (Public Works pesign Manual onUne Ilnk:m�uw.dzephyfiii�.fl,us/publle_works.asp) <br /> APPLICATION IS VOID UNLESS SlGN�W17'F�PROPER IDENTIFICATION AND WlTNESSED BY A PERMIT <br /> TEAifVIQAN QR NOTARY PUBLIG <br /> NOTEe The dty p}7.ephyrhlfis Ic not ree{wnalble for ma(Menenoe or repai�e of drPveWays, prlrewaye�ap ttot el�v/ <br /> Inberfere wkh mdatlnp stomiwaDer treatment and/or oorneyanp. <br /> PROPERTY O � By�gning tltls appllcatlon: I oertify that I have read and understand the owner/lwild�dlsdosure <br /> statemerrt. (ptease Inroap <br /> �Oh/1J//� ��ft-/ �rle// JR. / �.� � <br /> Appikant PrIM Name' Appli�nt Signadrte Da6e <br /> P�mlt Technldan Signatwe (or)Notary Signature p� <br /> Applicant fs( )pesonally Imown tn me or pmduced as Identifkatlon. <br /> (h�of Idmtlflcatlon) <br /> Page 2 of 3 <br />