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RULE 14-86.004,F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 850-040-06 <br /> DRAINAGE CONNECTION PERMIT ROADWAY DESIGN <br /> 10108 <br /> Page 5 of 8 <br /> PART 3—Certification by Applicant <br /> I hereby certify that the informati t ubmittal is complete and accurate to the best of my knowledge. <br /> Applicant's Signature: Date: 10/27/2020 <br /> Name(Printed):Jeffrey W. <br /> Title and Company: Manager and SF Zephyr Commons Outgarcels, LP <br /> Address:400 Clemantis St. Ste 201,West Palm Beach FL 33401 <br /> Phone Number: 561-578-8700 Email address �wprestonCc�nadg.com <br /> PART 4—Owner's Authorization of a Representative <br /> I(we), the owner, , do hereby authorize the following person, or <br /> entity, as my representative: <br /> Name(Printed): <br /> Title and Company: <br /> Address: <br /> Phone Number: E-mail address: <br /> Part 5—Affidavit of Property Ownership or Control and Statement of Contiguous Interest <br /> 1, Jeffrey W. Preston ,certify that I own or lawfully control the following <br /> described property: Parcel 7 of Zephyr Commons, Parcel Number 35-25-21-0130-00000-0070 <br /> Does the property owner own or have any interests in'any adjacent property? <br /> ❑ No ® Yes If yes, please describe. The property owner owns all of the commercial development,Zephyr <br /> Commons of which Parcel 7 is'a part of. Zephyr Commons is 63.39 acres and partially developed. <br /> Owner's Signature required for Parts 4 and/or 5 <br /> We will not begin on the drainage connection until I receive the Permit and I understand all the conditions of the Permit. <br /> When work begins on the connection, I am accepting all conditions listed in the Permit. <br /> Name(Printed): Jeffrey W. Preston, Manager <br /> Address: 400 Clematis St. St 01 West Palm Beach FL 33401 <br /> Phone Number: 56 - 0 <br /> Signature: Date: 10/27/2020 <br />