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<br />, ' <br /> <br />PERMIT APPUCATION <br /> <br />UTIUTIES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADOmONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPUCATION. <br /> <br />- <br /> <br />I t.tLf <br /> <br />"' <br /> <br />11~~r <br />v.-d')<') . <br />~;~~3 I <br />~ _ .ov...J <br />~ ~ ... <br />-cI ...g '" <br />. . ". V VI <br />V' ~.. . -+- <br />~v <:"" <br />-'fI ')' IS ~ ...L <br />. \\.It-!,. r;,..... <br />~ .- <br />oJ -.;, ~ ~ ~ '<I <br />>--dt) .~..t3 <br /><I oJ' ~ '^ ~:-? <br />J ('" "" ,,~~ <br />01 '';' ~ <br />.~ -: ~ ')0.. \'-+ <br />(. .. .' \u 0 () <br />..o-.J) <br /> <br /> c2 " <br /> ~ <br /> .... <br /> ;-3 <br /> ~ - <br /> <' .s _ <br />~ ::s ('o;r-- <br />"'" rt o ,." <br />D <br /> 0/1 <br /> VI \ );t "3 <br />\ ~ 'llI QI <br /> "* .- :> <br />-+- .. J <br />() c::.. 3 <br />-J .. - <br /> - .._w._o. w ~ d <br />I "{f 1ft \J <br /> I~ ;.0 <br /> QJ <br /> 1... <br /> <br /> <br />~ ~ <br />j ~ ~ <br />.,j <br />-f < <br />.. ..~ ~ <br />VI)'-J <br /> <br />.:;/ v~-, <br />--VI <br />d .J 0.- <br />'3 :J <br />..; + ~ <br />;;': ~ <br />::rfV' <br /> <br />AFfIDAVIT: Appllcatlon is hereby made to obtain a permit to do work and Installatlons as Indicated. I c:ert:Ify that all foregoIng <br />Information Is ac:cJrate and ttlat all work will comply with all applicable codes. I understand these codes shall take precedence over aU <br />approved construc:tJon documents, and Issuance- of this permIt Is verification that I will notify the property owner of Flonda Wen Law <br />req., F.S. 713. . <br />The Issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed <br />restrictions may apply to this property. <br /> <br />All wark shall camply with the culftJlt Florida Building Code, Public Worka c.lgn M8nU81 and FDeT c.lgn <br />Standards (If applicable). (Public Worlcs DesIgn Manual online link:. www.d.zet:.hyrhllls.n.l.IS/pubI1c..wcrlcs.asp) <br /> <br />APPUCA110N IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICAN OR NOTARY PUBLIC <br /> <br />NOTE: 'TIHI ~ at z.phyrhm. i. nat ~bl. far m.intmulllCll or rwpllirs at drtvIIwIrys. DrMlW8ys sh.1I not alter'/ <br />Inter1llre wtth exWtInll stDrmw6b.lr tN8tm.nt and 1 or CDlMlyllnce. <br />PROPER"N OWNERS: By signing this application: I certify that I have read and understand the owner/buIlder disclosure <br />statement. (please Initlal) ~ /I I / <br />J-t:,..ro\J Os.,'f.pep ~ ~ 2 07 <br />Applicant Prlnt Name pllcant SIgn Date ' <br /> <br />Permit Ted1nldan SIgnature <br /> <br />(or) Not:2Iry SIgnature <br /> <br />Date <br /> <br />Applicant Is { ) personally known to me- or produced <br /> <br />as identl1'lc::atlon. <br /> <br />(type of Identlftl:atton) <br /> <br />P8g. Z of 3C <br />