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� ', � � � ° <br /> :��w�+,r�n�Puca-riotv .�'G� ..�����,� .�' �-�I,�.n <br /> ~� _ Y7Tit.I'RES LOGATE Cfl�JFIRN➢h"ClCbiiti;�1UMB�R; � _ <br /> PROVYDE SKE'0'CH IN TFlI:S AREA, �F AD!l3S��:'�A�.��,�►�� ZS YtEQfl..�IRED,ATTACH TO Tlt�S <br /> APPLICA"!TO N. --,�- <br /> yl y`l � <br /> " � i � � ��t <br /> � � �j��I�h�;st�rrti►tt"ed j a"ee. <br /> �r-r�-,��•��'rrl��.�_.�.-��-�,•��Vf-���-�- . � . <br /> �� � _ , { � <br /> � 1iZ' r �� .r '�i � <br /> i ` ` �• � � ' <br /> y _ l � _f�... �rw`+(�•i.� � <br /> .�'� - /` vn'va t� <br /> � r' <br /> �"�iQc.�C.. rf+�'�}���,��'�` ,,,/ / _,�.�..`� ...� „ <br /> � <br /> IIlG � f,�' �0(�t.�..`� ,•'f s�- I . ! <br /> �� , �z�k � <br /> i '� ,� �l� �i <br /> � �' <br /> �� ,l . <br /> T�� �►�-� _ y�x�'� z � <br /> J 3�'y�oo�-�t}�� <br /> � f - � - - .�� _- - --=�� --�'- <br /> �- - �8 ��.'� "_�''����:�� �� .. .. _. -._- _ 'r - � <br /> �..--� _--' �. ,�'1�„11�1�"" '� <br /> � � <br /> , _ r- <br /> .:�,.:��._ - - � --- -- --- _ <br /> I � �� I <br /> 1 <br /> AFFIDAVIT: App]ic�tion is hereby+made ta obtain a pertrit tn do wusk at�d installations as indkated. I�fy triat a!f foregofng <br /> informatio►i is accura#e and that aU wark wllt comp[�r with at3 appt#cable cad[�. I unde�c!tt►es�c3odas st►a!!fake prec�dence over ati <br /> approved constru�tion documenis,and issuance of this g�rmii!s veriF�t.iosc tfiat I wili n�iljr tfie propert.y owrter of Ftarida tien i.aw <br /> req.,F.S.713. <br /> "the issuance af thIs permit does not ensure com�rliance wiih c'�eec!restriclions and I undA_rstand that addihona!deed <br /> nestrichons may a��1Y t�p this propterly. <br /> Atl work shaii�ampty vuii�h the cuvre�rt FIorir�a Buildinp Caate„Pu�iiic Wor�Des'rgn d�fanua!and I�OT Des�gn � <br /> St��dards(if 8pp0ic�carb�e). (Public Warks i7esign Manua!online!lrrk:www.a.zeph�itls.fl.usipublic_avorks.�p) <br /> APPLICATIt1�I IS VQID U�lLESS SIGNED WiTH PROPER IDENTIEICATION ANQ W�'NE55ED BY A PERMIT <br /> TEC!-lPIICSAN OR NCITA�tY PUBLiC. <br /> NtaTE: The�ty of Taeph�►ririft�is nat resp+anSil�le ftrr maerrt�anC:e C►r i�irs af tlrnreslrayS. 63siv�eaYs shaE!not elter J � <br /> iriber�ere rvith ex�4'finrg stoRnverater trea�trnent ar�d�or cociveyanee. <br /> PROP�R"FY OWNERS: 8y signing this appiication: I te:tify t#�at I have read and understand the ownerJbuilder disclosure , <br /> staterrterlt.._. .�(piease ini6ai} <br /> Appiicartt Prirrt tJ�me r ApplicanC Signature Date <br /> Permit TechNCian Signature ^ (or�Notary Signature � Date <br /> Applicant is( )Per.�natly knw+m W me or prcrduced as fdentiticaE3on. , <br /> (type af ider►lification) <br /> 4�ags 2�f 3 ` <br /> �� - -- - - � <br />