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I underst�r�d �h�t a s�parat� p�rr�it must b� s�c�ar�d f�r ��EC3'RIC. Pl.EJM�i�c�, SI�i�S, Pt}C}�S, FIJRNACE�, �{�ILERS,FiE«RT`ERS,Tld�KS,�IR CQR!€?BT'lC3�lERS,E7°C..... t�l�i�ER'S AFFi�A�ET': I cer�ify tFa�� ail th� for��oing informat'tan is �ccur�t� and Ch�t a}i vvcrrk wii3 b� d�n� Jn cc�rx�plianc� w�eh �!E appl�eable B�ws r���l��€r��constructi�ra�nd zc�nir�g. �r � "�"` p � ��. � [ � � � � �����.� �� ���� ������ ����� ��}� ������������ �� ���� �������. �� ��� ������ � � �� � � �� �� � �. � � � �� �,tt �t�trc�t��t�rpt�eant. ,4s cr�e�nc�Iticrn �c�th�issuarrce�f�brellding,�errral��vr`ttr�rn�stimc����#vadu�e��eec�Jrag�2.�E1�, �h€��ppff�arrt rnus� �rom�s�ix� gc��c��`t�ith t�hrrt a co�+y�f�h�rratice�f�°�mrnenc�rrten��nd c�rs��ructton 16�n Icrs�6rochure wilt��delitr�rea'te� th�p�rscarr Vvhrzs�prc�,verty�s s�r�J�et to�rtt��hrn�rzt. 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C�UVNER c�r AC� �#T �t��3TRA�i"G1R r Tt��foregcatn�t�strurr�erat was ac�r�e�wDg���d befor�tre�this Th�for�going 6r�strurn��tt w�s acknow��dg��befe�re r��this c�� d�y c������ � 20 t�(� ,}�Y �" �,d�y�f �'� .2t} .�- ..� by ��s�� ����� ��- ' wh�is p�rson�l�y knawn ta t���t �''��� ` � �ha is p�rsc�nally kna�vn�o me or wh�has produc�d t�� �� �,s�ar� as m�or wha h�s pr�duced �s iclengificati�n and wh�d�d t�k�ar��at�a, Ident6f€cat��n and v�hrs � a.�- �._ itl��Pl��CIlcd���; ''� tYf�Kr ���}��}'�1��.�F��1��i��.�.� �tGTAltYPE1�t,1�. ,,•�s;'' ��;"�, NatacyPu�i�c-St�te�tE�orida � "�; a: _, R „ C47ttR7f5S+Qtt�GC�l5(}54� a �} t � •z.' �lites�LJctA1�a,2021.__ � t� . ����.�"' � i� ,� tiatbnaShol�s Axsn. �3l�tl' ++r��tos�+�'' Ht+ndcdi#ipugh Y ' �I� �, PF�P1�t � PCIfl : ` .�� �"�;; .t�AlNI��R�fA���IY�U Se�l: :'i��:. ��/�R}'y�j{{7@�ny/��� /��!�+�(�{� Se�l: �,`ke e#;, PFII�LtyV�pf9T(i�FgItgl+��7t?l!idi'L�4}\7$G�y'rya*S6�V }, �t, . >�+ GPAi`€BSG�.+d qy, tP�FKL4 t� }�'�OF�QPe``� S'N��� Q� �sM���s�����F����p���#���k������' ���A��s�������ak�������t���M��+h��W���k��M�������k�����#����&��k��^���ri�����k���sk����������� APPRC}VEQ BY � Pdans Exat�niner �t�rtin� SYructc�r�f R�vi�w Gl�rk � �} � �] �n {, p �.'�; I� }J�..�; �,,,,'O 1 P�A �6 � 1. .�,... ���.." .f���.`�-*� �� � ,�.� �wr��r's IVarr�e (Fe� Sir�pleTitl� Flc�ld�r�: ������� �-������ '��`� .�° � `° ��� . �-��`�. �-���'��� E ,� �,i,� PhC�Ct�• �� � � �wr►�r's Address. ��;��� „���- ���°���� ��~ d �rty; :��� ���� ;����.� St�t� �`��` � Zip ��d�. ,�� .a,t�;� Jc�b Addr�ss (wh�r� �rv�rk is b�in� dca��}: ����`�� ���v ���"� �"'��� �.� ` , Ci�y: i� � Sh�r�s St�t�:�Fl�ri � Zip C�d�: ��=� � `�� ��r�tr����r's �e�rr�p�r�y I��rr��: ��,�.c�a � �'��� .�������-��.��� ' �` �� Ph�r�� : ���,���� ..� ���. �n��� 1�ddr�ss: � ��_���� ����������t��.�� � �����,� ���� �. �ity: ��"�� �������° Stat�: ��� Zip C�d�: ��� =,� C��ali�Fi�r`s N�m� : .���������� ��;�r�� ��� � ��� � ���. Nurrtiber; ��� ������_����-�"� �4rchiteetJ Engin��r c�f R�cc�rd N�me: Phc���: ,4ddr�ss: �ity; State: Zip ��d�: � ���ri e �rk: ���'1���-�' ��`��_���.�`� ��°=�� I �r� y c�rt�f t �t t � �r s � r� � �� r�� �r� J r th� ��r�tr� �rj�r� it�ct is �r�� 1� r r� illir� t� � I�t� t � � r�fir�c�. 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