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From:B&H CONSTRUCTION 03/18/2011 13:52 �137 P.003/003 <br /> PERMIT APPLICATION �I.� V ✓ Q� �� � ''r' � s <br /> � V <br /> �� <br /> UTLL�TIES LOCATE CONFIRMA'RON NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APP�ICATION. <br /> yo �^ � .� <br /> r i <br /> 4 S � �fS <br /> � <br /> s�' <br /> � J1 �.6 <br /> , ,�s� E,,�sY�° E,nsl��l t,a <br /> Ii �� le� <br /> ��, <br /> rs ��� s� /�D,D� <br /> � q- '�s' .r , � ri ��ST�N6 D,eiti/E <br /> a <br /> �, MGS}.rd,FES �D w� <br /> , <br /> a <br /> S � . W <br /> ,� <br /> �� o � <br /> � <br /> l3 � W 3' x 7" T�AN6��'e <br /> � �c.��¢6 <br /> �!w cvr 4YE�r�> �� SYqc.c �gEe q�iay �ai�rT' <br /> AFF7DAVfT: Appllcation Is hereby mede to obbin a permft E� do work and installatlons as IndkaOed, I ce�tify that afl forepoinp <br /> infamatlon is acausoe and tlwt all work witl aom0ly wRh ea applftsbk oodes. I unddstand tlxse cndes shall talie preccdenoe over all <br /> aDP�ed aonstructton dowments, and issuanoe of thls pemM[ Is reNficatlon that I wiN notify the propert�► owner of fbrida lkn Lsw <br /> req., F.S. 713. , <br /> The issuance of this permit does rpt ensure aumptlanoe with deed restrictior� and I understand tt�at addltlonal deed <br /> �dions rnay apply �p this property. <br /> All woric shall comply wkh the current Fbrida Quiidinp Code, publk WoMcs Dasipn Manusl and FDOT Desiqn <br /> Standards (If applki6io). (Public Works Orsiyn Manual onik�e �nk: www.d.zephyrhiHs.fl.us/Pub�ic w�o�Ics.asP) <br /> APPLICATION IS VOID UNLFSS SIGN� WITH pRppER IDENTIFIC�4TION AND WlTNESSEp BY A PERMIT <br /> TECFINICIAN OR NOTARY PUBLIC. <br /> NOTE: The City d ZaplryM�ills is not ►a�pondbla for n�ain0�nsnos er n�afr� of dri�rewars. Drirewsrs sinll no! NOK / <br /> I�Eerlbne with az�dnp stsnnwsbr tnatnw�t and / or oonrsysnae. <br /> PROPERTY OV1mIERS: By slgnirg thLs applltation: I cerUfy that I have c�ead �d understand the owner/builder �sdowre .. <br /> ��G (please iNtiat) <br /> �r�S �t�L nd..� ..t� 3-/'�=!/ <br /> Idfnt Print Name Appl t SipnaWre pa� <br /> , � � 3-�6 -�� <br /> It Tecbn an Signahire �a) �ry �� �� <br /> !►Dplicant is () Pasona�to me or produced as identiFcatlon. <br /> (type of identlfication) <br /> Psye 2 of 3 <br /> ZOO/Z00'd 9EZ�` ZI�EI 1lOZILI!£0 ;�p�j <br />