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<br />. . <br />,r PERMIT APPUCAnON <br /> <br />UTILITIES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADomONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br /> - <br /> - <br /> . <br /> .;: -d \. <br />tr -J ~ ~ <br />"" ") C' <br />tJ' ':>.. ~ <br />\lIo * <br />.....g . <br />.> <br /> ~ - cJ <br />"'" 'f' '<t c <br />- ~ .6 <br /> '"' u a <br /> \J ,Q -l <br />(' VI <br />"^ -d ....g VI :J '3 <br />~ w <U QI <br /> l. -+- ~ ...- :> <br />~ Q 0 /j <br /> -1 .. <br /> 0- -' <br /> --.-.-...-....-... ~ <br /> <J <br /> I~ ~ <br /> <II <br /> i. <br /> <br /> <br />11'::!"{f <br />v .- ~ )0 '3 . <br />=: -' .., 3 <br />.:jl-~)c <br />3 _ .-v ~~ <br />~ - ... <br />~ -.9 ~. \ VI <br />VI ::>"a . -+- <br />~ v <:: "" <br />-TJ 3.'iS ~ -L <br />r !: t-\ Pi._::: <br />0,$"1/1 ~-' <br />...~ " .. <br />>-.-0 l) .~.f 3 <br />d '" ~ '^ ~:-!' <br />).<:,,,,, ~..C'l'" <br />Of <II ~ <br />.~ ':ft. '>.. ,"4- <br /><. ... ., \U 0 () <br />...:::::l'-.l) <br /> <br />.." . <br /> <br />~ ~ <br />j -' ~ <br />-r ( <br />.. .... " <br />"^ ) '-J <br />.::I "t.... <br />-;~VI <br />'3:.10- <br />...; -4- <;:) <br />.. - ~ <br />V':r~ <br /> <br />AFFIDAVIT: Appllcatlon Is hereby made to obtain a permlttc do werle and Jnstallatlons as Indicated. I certlfy that all foregoIng <br />information Is aCCJrate and that aU worle will comply witt! all applicable cedes. I understand l:t1ese codes shall take precedence over all <br />approved construction dOQJments, and Issuance of this permit Is verification that I will notify the property owner of Florida Wen Law <br />req., F.S. 713. ' <br />The Issuance of this permit does not ensure compliance wlth deed restrictions and I understand that addItional deed <br />restrictions may apply to this property. <br />All work shall camply with th. CUmlnt Flartda Building Code, Public Works ee.lgn Manual and FDOT o.Ign <br />Standards (I' appJlcab"). (Public Works- DesIgn Manual online IInJc:. www.d.zephyrtlllls.n.US/publll:.-worics.asp) <br />APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TEOiNIClAN OR NOTARY PUBUC <br /> <br />NOTE: TIMI CJty at ZephyrhUIs i. nat ~bl. tor rna.......ftCII or I'Wp8irs at drtvwnIy& Dnv.ways sh.,1 nat alter I <br />1nt8r1'11re wtth exiKingstDrmw6b.. tneth..nt and I orconvepnCII. <br />PROPERTY OWNERS: By signing thfsappllc:atlon: I certl1Y that I have read and understand the owner/builder disclosure <br />statement. (please Initial) ~ J I / <br />ll..ro IJ O.Jj : I !,e,;. . . ;; ~ 'B 2... 0 7 <br />Applicant Print Name Ap Ilcant S1gna11l Date ' . <br /> <br />Permit Ted1nidan S1gnaturl! <br /> <br />(or) Notary Signature <br /> <br />Date <br /> <br />Applicant Is ( ) personally known to me or produced <br /> <br />(type at IdentffltaUon) <br /> <br />as Identlftcatton. <br /> <br />P8,.. 2' 013 <br />