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<br />D:ISCLOSlIRB STATBIIBlIT PaR OWBBR <br />C:In OF ZBPHYRB:ILLS BUJ:LD:IBG DBPARTIIBNT <br /> <br />I, <br />agree to the provisions of this instrument. <br /> <br />have read and fully understand and <br /> <br />The undersigned states and affirms that he or she is desirous of constructing, <br />renovating, adding to or reroofing his or her own domicile, that he or she <br />actually occupies, or will. occupy by said domicile, and same is not for <br />rent, l.ease or sale. That he or she shal.l. comply with the fol.l.owing conditions: <br /> <br />1.. <br /> <br />2. <br /> <br />3. <br /> <br />4. <br /> <br />5. <br /> <br />6. <br /> <br />7. <br /> <br />8. <br /> <br />9. <br /> <br />DATE <br /> <br />5/~1o'f <br /> <br />. <br /> <br />PERII:IT # <br />