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<br />. 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 />f3 <br />~ - <br /><'l .s <br />:1 c <br />Ii 0 <br />D <br /> <br />oft <br />VI <br />t:lO 'III <br />"4- <br />-+- 0 <br />j c::. <br /> <br /> <br />11~~r: <br />v.~IS)c") .' <br />~~~~3 . <br />~ _ .'-1"" <br />a. - .. <br />-a ~ -.J <br />.' ". V VI <br />V' :>.. Cl . ... <br />;t v .'<: VI <br />-TI ') 'cS":: ../ <br />r~l-\. ~._:::: <br />.{ '':' ;C ~ II> <I <br />>-.-d a .~..f 3 <br />d "'~ ..,., ~7! <br />J.:f"\ ~-'l'" <br />.., <.n l:l.. <br />.~ -:::f. ')... \ "+ <br />'- .. ., \.u 0 Q <br />...0"';) <br /> <br />.J <br />I; <br />.6 <br />....J <br /> <br />'3 <br />QI <br />:> <br /> <br />~ ~ <br />j J ~ <br />-f" < <br />.. ..1 ll\ <br />V\J'-J <br />.>' ,,\..... <br />-;~Vt <br />3.:]0- <br />..; ... ~ <br />v.:: ~ <br />::r[VJ <br /> <br />- <br />d <br />\l <br />.-() <br />QJ <br />f.. <br /> <br />AFFIDAVIT: Appllcatfon Is hereby made to obtain a permit to do work and Installations as IndIcated. I certify that all foregoing <br />InfcnnatJon Is aCCJrate and tt1at all work will comply with all applicable cedes. I understand these codes shall take precedence over aJI <br />approved construction documents, and Issuance of this pennlt Is verff'lcatfon that I wm notll'y the property owner of Florida Wen Law <br />req., F.S. 713. . <br />The Issuance of thIs permIt does not ensure compliance with deed restrictions and I Ul"lderstand that addItional deed <br />restrtc:tlons may apply to thIs property. <br />All work slNllI camply with tha current florida Building Cacta, Public Works c.lgn' M8nual and FDeT DesIgn <br />stancl8rds (I'appllcabla). (PubliC Worlcs DesIgn Manual online IInlc:.www.d.z~hyrtllIls.t1.US/PUbllc..worlcs.asp) <br /> <br />APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNlCAN OR NOTARY PUBUC <br /> <br />NOTE: 11M CJtv at z.phyrtIm. i. not ........bl. far mBintHllnce or ....rs at drfnw8ys.DrfVIIW8yS stI... not altltr I <br />lnt8rfere wtttJ ....nll stDnmnb. tNMm.nt and I or CD!1VIIyIInce. <br />PR.OPERTY OWNERS: By signing this application: I certlfY that I have read and understand the owner/builder disclosure <br />statement (please Initial) ~ /I I / <br />J.-lc:...ro\cl O~"'.bet:7 ~ K 2 07 <br />Applicant Print Name pllcant SIgn . Date ' <br /> <br />Permit Technldan SIgnature <br /> <br />Date <br /> <br />(or) NotZIry SIgnature <br /> <br />Applicant Is ( ) personally Icnown to me- or pmduCl!d <br /> <br />as Ident:lt'Jeatlcn. <br /> <br />(type of Identftlt:atlon) <br /> <br />PBg.. % of 3: <br />